Student Application Form

A. C. Bessette Scholarship

Instructions: Please Print Clearly or Type and return completed form to:

A. C. Bessette Scholarship Committee
c/o Social Sciences Department Chair
Community College of Rhode Island
400 East Avenue
Warwick, RI 02886-1807

Applications must be hand delivered by 4 p.m. or postmarked no later than April 1.

Name________________________________________ Student I.D. #_____________________

Address_________________________________ City________________ State____ Zip_______

Telephone__________________________________ email_______________________________

1. Are you a graduating student? Yes__ No__

2. Do you have 60 credits towards graduation? Yes__ No__

3. Have you taken a minimum of four (4) courses in three (3) different Social Sciences disciplines? Yes__ No__

Discipline _______________________

No. Courses Taken _______________

____ Economics ___ History ___ Philosophy ____ Political Science ____ Sociology

4. State your Social Sciences G.P.A. (must average 3.5) _______

5. State your overall G.P.A. (must average 3.0) _______

6. Why do you think you should be selected as the A. C. Bessette Scholarship recipient? (attach
maximum 1/2 page response)?

7. Please obtain the signature from a Social Sciences' faculty member to nominate you for this award.

_______________________________________________
Signature of Social Sciences Faculty Member/Date

8. Have you applied for other CCRI scholarships, funds or awards? Yes___ No___

If yes, please list:

I grant my permission to the Scholarship Review Committee to review my academic standing with CCRI’s Office of Admissions and Records, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes.

__________________________________________
Student Signature/Date

Important Note: Scholarship recipient is required to write a thank you note (memo and sample thank you note) to the scholarship donor, and provide a brief biography (printable bio form) about themselves and their education/career goals and return both to: Geraldine Peixoto, CCRI Foundation, Flanagan Campus, 1762 Louisquisset Pike, Lincoln, RI 02865. Please contact the CCRI Foundation if you need assistance in completing this responsibility at 333-7150 or e-mail at foundation@ccri.edu.