Our Lady of the Miraculous Medal Parish
Hampton, New Hampshire

Msgr. Matthew J. Casey Scholarship

SCHOLARSHIP APPLICATION

Application Date:_________________

Name of Student:________________________________________________

Date of Birth:__________________

Address:
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Home Telephone: ___________________

High schools to which you are seeking admission:

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Please explain any unusual expenses in the recent past or anticipated in the near
future that may affect your parent's ability to contribute to your education: 

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List your significant school-related contributions and activities (e.g., sports,
dramatics, class government, etc.)

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School Honors and Awards:

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List your significant Church or community contributions and activities 
(e.g., altar server, lector, Girl Scouts/Boy Scouts,  etc.)

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Church/Community Honors & Awards:

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In the space below (use additional paper if necessary) discuss anything you
would like to tell the Awards Committee about yourself that would help the
Committee to know you better and/or better qualify you for this scholarship.

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               Signature of Applicant

Parish Membership Affidavit | Scholarship Instructions

Revised Nov. 14, 2004