Application Form

WEST CATHOLIC ALUMNI ASSOCIATION

PRO DEO ET PATRIA

FOR GOD AND COUNTRY

Long Live the Burrs!

APPLICATION/NOMINATION FORM FOR THE

WEST CATHOLIC ALUMNI ASSOCIATION

COMMUNION BREAKFAST SCHOLARSHIP

Deadline – July 31, 2008

NAME OF STUDENT:_________________________________________________________

ADDRESS:___________________________________________________________________

CITY/STATE/ZIP:____________________________ TELEPHONE:____________________

PARENT(S)/GUARDIANS: ______________________________________________________

SCHOOL ATTENDING: ________________________________________________________

CATHOLIC PARISH OF WHICH STUDENT IS A MEMBER:_____________________________________________________________________

HAS THE STUDENT REGISTERED AT WEST CATHOLIC? __________________________

PLEASE LIST ALL ACADEMIC HONORS THE STUDENT HAS RECEIVED (Please use other side if needed): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE LIST ALL OF THE STUDENT’S ACTIVITIES, CLUBS, SPORTS, ETC. (Please use other side if needed): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE LIST ANY OTHER FACTS YOU WOULD LIKE THE COMMITTEE TO CONSIDER (Please use other side if needed): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NAME AND PHONE NUMBER OF PERSON NOMINATING STUDENT:

_____________________________________________________________________________

PLEASE RETURN THIS FORM BY JULY 31st, TOGETHER WITH A COPY OF THE STUDENT’S MOST RECENT REPORT CARD AND A COPY OF THE FINANCIAL AID FORM SUBMITTED TO WEST CATHOLIC TO: WEST CATHOLIC ALUMNI ASSOCIATION, COMMUNION BREAKFAST SCHOLARSHIP COMMITTEE, P.O. BOX 889, ARDMORE, PA 19003-0889.

For more information, call the Alumni Association at 215-387-8560