Student Application Form

Carosi / SkillsUSA Scholarship

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

Mr. Joshua Klemp
SkillsUSA
CCRI
400 East Avenue
Warwick, RI 02886

Applications must be hand delivered by 4 p.m. or postmarked no later than March 16.

Name________________________________________ Student I.D. #_____________________

Address_________________________________ City________________ State____ Zip_______

Telephone__________________________________ email_______________________________

1. Are you entering CCRI or have you completed one year at CCRI? Yes__No__

2. Are you in one of the following programs of study?

Allied Health Yes__ No__

Business Administration Yes__No__

Computer Studies Yes__No__

Engineering & Technology Yes__ No__

General Programs Yes__ No__

Industrial Technology Yes__ No__

Nursing Yes__ No__

Administration office Technology Yes__ No__

3. Have you been involved in a student run organization? Yes__ No__

Name of student run organization_________________________________

4. What is your G.P.A.? __________

5. Please (on a seperate sheet) submit an essay on why you should receive this scholarship. Include information on your leadership skills.

6. 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 Enrollment Services, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes.

Student Recipient must agree to continue/become a member of SkillsUSA at CCRI.

_____________________________________
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.