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James B. Collins Memorial Fund, Inc. Scholarship Application

(Applications, including attachments, must be received by February 9, 2024, all data must be complete)Please type or print legibly
Applicant (Student) Data

Name:________________________________________________________ Telephone: (_____)_______________________

FIRST M.I. LAST Alternate Number ( )_________________
Home Address: (Include Zip Code) ____________________________________________________________________________________ _______________________________________________________________________________________________________________________E-Mail Address: ______________________________________________________________________________
Anticipated School Choices: 1st Choice: ________________________________ 2nd Choice: ________________________________
Anticipated Field of Study: _______________________________________________ (Major)_________________________________
Scholastic Achievements: Grade Point _________ of Maximum _________ (Attach documentation) Class Standing ________ of ________
ACT/SAT Test Scores (Attach documentation) You need only one, but you may include both. If you did not take one of the tests, please indicate by inserting “N/A.”
SAT Testing Date ___________Score___________ ACT Testing Date ________________ Score ________________
How did you hear about the James B. Collins Memorial Fund, Inc. Scholarship? _________________________________________________
This is the only form that may be utilized to submit an application.

In 150 words or fewer, please provide comments on your leadership ability and activities of service to the community(applicant may attach documentation of any leadership honors or recognition of service to the community):








Provide an essay of 250 words or fewer. Essay must address Career/Academic Goals and Financial Need (for example, (1) student receives no parental or financial support (2) student’s parents are unemployed (3) student is single parent (4) student is head of household (5) student is independent (6) student is dependent living with single parent (7) student is unemployed (8) student is in foster care, homeless or an orphan). What do you want to accomplish? What specific cir-cumstances prompt the need for financial support? .





James B. Collins Memorial Fund, Inc.Scholarship Application Checklist



Full Name_____________________________________________________
Street Address:__________________________________________________
Email Address:___________________________________________________
Phone Number:___________________________________________________
Place this check list on top of your Scholarship Application.Check each corresponding box that has been completed to ensure your submission will be accepted for consideration.
[ ] Documentation for your grade point
[ ] Documentation for your ACT/SAT results
[ ] Completed Essay
[ ] Two letters of recommendation
[ ] Completed application
[ ] Verified correct mailing address and phone numbers
[ ] Mailed before due date
Thank you for the submission of the JBCMF scholarship application. For Official Use Only 2024