Our Lady of the Miraculous Medal Parish
Hampton, New Hampshire
Msgr. Matthew J. Casey Scholarship
Instructions: This Affidavit must be signed by the applicant who should then present himself/herself to the Pastor to confirm scholarship eligibility.
I, ______________________________________, an applicant for the Right Reverend Monsignor Matthew J. Casey Scholarship, do hereby state that I am a member in good standing of Our Lady of the Miraculous Medal Parish.
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Applicant
Signature
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Date
The above applicant has presented this Parish Membership Affidavit in accordance with the requirements for a scholarship award by a committee of members of the Holy Name Society and I hereby certify that he/she does qualify for consideration of such an award.
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Pastor's Signature
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Date
Submit this Affidavit with the Scholarship
Application
Adopted February 2, 1983