Beth Brown Memorial Foundation, Inc. www.bethbrownfoundation.org

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Scholarship Application

Please list other scholarships for which you have applied, the amounts and whether or not the scholarship
has been awarded to you. If you have not been informed at this time, please indicate this with uncertain.

Scholarship	Amount	Awarded (Y/N/?)
____________________________________________________________	______________	______________
____________________________________________________________	______________	______________
____________________________________________________________	______________	______________
____________________________________________________________	______________	______________
____________________________________________________________	______________	______________

To what schools have you applied? To the best of your knowledge, what are the anticipated costs for each school?

School	1 yr. Tuition	Room / Board	Books	Labs

How are you planning to pay for your education? Please give approximate percentages below.

Parents / Relatives

Personal Savings

Scholarships / Grants

Student Loan

Other

= 100 %

List school related extra-curricular activities by year (add pages as needed):

______________________________________________________________________________________________________________________

List activities and/or responsibilities at home and in the community by year (add pages as needed):

______________________________________________________________________________________________________________________

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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