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Scholarship Application
Back Home The Beth Brown Memorial Foundation, Inc.
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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, Post Office Box # 647, West Liberty, Ohio
43078 U.S.A.
Name:
_______________________________________________________________________________________________________
Address_______________________________________________________________________________________________________
____________________________________________________________________________________________________________
Birth date: _______________________________ Age:
_______________________ Phone Number: (____)_________/_____________
Graduation Date: ____________________________ Total Number in Class:
______________________ Your Rank: _________________
High
School Attended:
_______________________________________________________________________
( Please attach 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:
________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Remember: For consideration you must meet the deadline of March 15th
including having your three letters of recommendation,
ACT and SAT scores
( when necessary ) and transcripts sent along
with this fully completed four page application.
No incomplete applications will be considered.
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