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The Beth Brown Memorial
Foundation, Inc. Page 1
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Scholarship
Application
Deadline for submitting this
application is March 15th
Mail to: The
Beth Brown Memorial Foundation, C/O Mary Neal Miller, Chairman
312
West Baird Street, P. O. Box 647, West Liberty, Ohio 43357
Name: _________________________________________________________________________
Birth date:______________________
Address_______________________________________________________________________________________________________
______________________________________________________________________________________________________________
email: ____________________________________ SSN:
_______________________ Phone Number: (____)_________/_____________
Graduation Date: ____________________________ Total Number in Class:
______________________ Your Rank: _________________
High School Attended:
_______________________________________________________________________
(Include transcript.)
Name of Father:
______________________________________________________________________ Age:
______________________
Father's Address:
_________________________________________________________________________________________________
Father's Telephone Number: ( ____ ) ____/____________ Father's
Occupation: ________________________________________________
Father's Employer:
________________________________________________________________________________________________
Name of Mother:
_____________________________________________________________________ Age:
________________________
Mother's Address: _________________________________________________________________________________________________
Mother's Telephone Number: ( ____) _____/____________ Mother's
Occupation: _______________________________________________
Mother's Employer: ________________________________________________________________________________________________
Names, ages, occupations and home addresses of brothers and
sisters: ________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
NOTE: The deadline of March 15th
includes having three letters of recommendation; ACT and/or SAT scores;
transcripts and completed application sent to the address listed
above. No incomplete applications will be considered.
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