Print out this form and mail to B. Stevens, Scholarship Trustees, The Chatham Women's Club, 97 Round Cove Rd., Chatham MA 02633
Call Betsey Stevens, 945-2858 for information on this application.

Application for Scholarship

REQUIREMENTS: Applicants must be graduates of Chatham High School or residents of Chatham who have completed at least one year of higher education. Part time students will be considered. Applicants must submit a letter of request including a statement of career goals to The Chatham Woman's Club with this form by July 31, 2008.

Name:___________________________________________________________________________ Phone: _____________

Address: _________________________________________________________________________ P.O. Box ____________

Town ____________________________________________________________________________ Zip Code ___________

Parents Names/Address: ________________________________________________________________________________

_____________________________________________________________________________________________________

High School _____________________________________________________________________ Year Graduated _________

College ______________________:_________________________________________________ Major __________________

Tuition __________________ Board ____________________ Books __________________ Other _______________________

Please include three current letters of reference with this application: one personal and two academic (college).

1. Name: __________________________________________________________________ Phone: ______________________

Address: _______________________________________________________________________________________________

2. Name: __________________________________________________________________ Phone: ______________________

Address: _______________________________________________________________________________________________

3. Name: __________________________________________________________________ Phone: ______________________

Address: _______________________________________________________________________________________________

Please include official transcripts with this application.

List scholarships, financial aid, work grants, employment, etc., you will receive for the coming year from your college and private sources.

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

__________________________________________________________________________________________________________

I give the Scholarship Committee permission to check my references and to corroborate the above information.

Signed____________________________________________________________________ Date ________________________