BARNEGATHIGHSCHOOL：巴尼加特湾中学.docVIP

BARNEGAT HIGH SCHOOL CLASS OF 2013 SCHOLARSHIP DONATION APPLICATION Title/Name of Scholarship: Name of Contact or Representative: Name of Individual Donor/Organization: Street Address: Email Address: City: State: Zip Code: Telephone Number: Cell Phone: Amount of Scholarship: $ PLEASE DO NOT INCLUDE MONEY/CHECK WITH THIS APPLICATION Please check if you have your own Scholarship Application (if so please include): Please check if you require an essay ________ Signature of Donor or Donor Representative Conditions for Recipient to Receive Scholarship: Conditions: Please check which selection process you prefer: _____I agree that the Barnegat High School Scholarship Committee shall determine the recipient of this award. The BHS Scholarship Committee will notify me of the identity of the recipient before scholarship night. _____I prefer to determine the recipient of this award. _____I need a list of students in order to choose the recipient {specify what type of list below} Please return application to the following address: Contact Information: E.C. Peters, BHS Scholarship Coordinator 609-660-7510 EXT. 7060 Barnegat High School FAX 609-698-6313 180 Bengal Blvd. epeters@ Barnegat, NJ 08005 For example: The donor can stipulate that the recipient of the scholarship must be entering the field of medicine, OR must have a 95 grade point average, OR must have attended a particular elementary school, etc. The donor can place as many conditions on the scholarship award as they see fit. The Barnegat Township School District complies with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, Ti