Page Title

POLISH CULTURAL FOUNDATION

CLARK, NEW JERSEY, USA

SCHOLARSHIP

POLISH CULTURAL FOUNDATION

APPLICATION - ___2010_____ SCHOLARSHIP YEAR

Check one [ ] LUBOMIR and IRENE ZABILSKI SCHOLARSHIP

[ ] IRENA MIECZYSLAW NIZNIK HALOHA SCHOLARSHIP

[ ] JOSEPH S. ROZANSKI SCHOLARSHIP

[Preference will be given to the following field of study

Journalism, Media, Political Science, Social Work ]

The Polish Cultural Foundation grants a number of scholarships to deserving students in need of financial assistance. Only one [1] award shall be given per applicant.

QUALIFICATIONS: Applicant must:

1. Be a New Jersey resident, of Polish descent, U.S. Citizen or permanent resident.

2. Be undergraduate student, having completed the freshman year at an accredited college or university

3. Have a cumulative GPA of 3.0 higher.

4. Submit with this application a completed financial student aid report ( SAR or FAFSA ).

5. Provide an official transcript from all colleges or universities attended.

DIRECTIONS;

All items on the application must be completed, typed or clearly printed. Incomplete forms will not be considered. Forms must be sent to the Scholarship Committee Chairman. All applications are to be received by April 5, 2010 to include a 2 ½ X 2 ½ inch picture (passport size). Faxed applications will not be accepted. Community college graduates or transfer students must provide verification of acceptance by the school to be attended during the scholarship year as well as an official transcript from all colleges attended. Applicants may telephone the Scholarship Committee with any questions concerning the application. The selection procedure may involve a personal interview. Interviews will be conducted May 3 thru May 14, 2010. Each applicant will be notified of his/her status on or about June 1. All award decisions are final.

1. Name ___________________________________________________________________________

Last Name First Name Middle Name

2. (a) Present address_______________________________________ Phone _____________________

City _____________________ State _______ ZIP Code __________ E-mail _______________

(b) Permanent home address ______________________________ Phone _____________________

City _______________________________ State ___________ ZIP Code __________

3. Place and date of birth ______________________________________________________________

4. U.S.Citizen: ___Yes ___No. If permanent resident, your Alien Registration Number _____________

5. Social Security Number : _ _ _ - _ _ - _ _ _ _

6. Explain your Polish heritage __________________________________________________________

7. Family Background:

(a) Marital Status: ____ Single ____Married Spouse’s name ______________________________

Occupation ________________________ Place of employment__________________________

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(b) Father’s name _____________________________________________ Living:____ Yes____ No

Occupation _______________________ Place of employment______________________________

Occupation _______________________ Place of employment ______________________________

8. Educational Background

(a) Name and address of school you will be attending this school year _________________________

_________________________________________________________________________________

(b) Level of education ( at start of next semester )

Sophomore____ Junior ____ Senior ____ Other __________________________________________

Majoring in :___________________________ Credits required:________ Credits completed ______

School/ Location Date From/To Major Year Grad Degree

_____________________________________________________________________________________

High School – Name, Location, years attended, year graduated

_____________________________________________________________________________________

9. Financial Information: (Financial information provided is strictly confidential and for committee use only.

(a) Projected expenses and financial resources for the academic year the scholarship is to be awarded.

Projected Expenses Estimated financial resources

Tuition _________________ Funds from student employment _________________

Room & Board _________________ Funds from parent/guardian _________________

Books _________________ Scholarship Awards _________________

Other (specify) _________________ Tuition Waivers __________________

Loans __________________

Other (Specify) __________________

Total Expenses _______________ Total __________________

(b) Name and age of other family members who will be attending college during this academic year..

Name Age School Year (undergrad/grad)

____________________________________________________________________________________

_____________________________________________________________________________________

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10. If there are financial circumstances or special circumstances you wish to bring to the attention of the Scholarship Committee, please explain on a separate attached sheet.

11. Have you previously applied for a scholarship from the Polish Cultural Foundation? ___ Yes ___ No

Year applied _________________ Received _____ Not Received _____

An applicant may only receive one (1) scholarship award from the Foundation Scholarship Program.

12. How did you learn of the Foundation’s Scholarships? ________________________________________

13. List and describe your school related extracurricular activities and other current interests.(Use additional sheets if needed.)

___________________________________________________________________________________

14. Attach a one page ( Typewritten, double spaced ) original essay written in English answering

“ Is my vote important ? “

15. Enclose two (2) letters of recommendation in separate sealed envelopes. One must be on institutional letterhead from a faculty member attesting to your academic qualities. The other from an individual of your choice who has known you for at least two(2) years.

16. Name and address of your home town newspaper: __________________________________________

___________________________________________________________________________________

I hereby certify that all of the information I have provided in this application is to the best of my knowledge complete, true and correct.

_________________________________________ ______________________

Signature of Applicant Date

______________________________________________________________________

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SCHOLARSHIPS

The Polish Cultural Foundation, through its Lubomir and Irene Zabilski,

Joseph S. Rozanski and Irena Mieczyslaw Niznik Haloha Endowments,

is offering a number of $2000 scholarships for the academic year 2010-11.

SCHEDULE:

Applications must be submitted by : April 5, 2010 Interviews will be conducted : May 3 – 14, 2010

Award notification : May 25, 2010 Award presentation : June 4, 2010

ELIGIBILITY REQUIREMENTS

Applicant must:

1. Be a New Jersey resident, of Polish descent, a U.S. Citizen or permanent resident. A 2 X 2 in [passport size] picture must accompany application.

2. Have completed the freshman year at an accredited college or university

3. Have a cumulative GPA of 3.0 or higher.

4. Submit a financial student aid report ( SAR or FAFSA )

5. Provide an official transcript from all colleges or universities attended

Application form is available through the Financial Office or at the

Polish Cultural Foundation, 177 Broadway, Clark, N.J. 07066 or at

www. Polishculturalfoundation.org

Send completed applications to:

Polish Cultural Foundation

Scholarship Committee

177 Broadway Clark, N J 07066

SCHOLARSHIP APPLICATION

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