DATE:_______________

BRIAN O’MALLEY MEMORIAL
SCHOLARSHIP APPLICATION

YOUR NAME_____________________________ S.S.#________________________

ADDRESS ____________________________  PHONE#________________________

HAVE YOU APPLIED TO A COLLEGE OR UNIVERSITY FOR ACCEPTANCE? YES___ NO___

HAVE YOU BEEN ACCEPTED? ____YES _____NO

WHAT AMOUNT OF FINANCIAL HELP CAN YOU EXPECT FROM FAMILY?

___NONE ___MINIMAL AMOUNT ____MODERATE AMOUNT ____SUBSTANTIAL AMOUNT

DO YOU PRESENTLY HAVE A JOB? IF “YES”, WHERE ARE YOU EMPLOYEED AND WHAT

IS YOUR JOB DESCRIPTION?

________________________________________________________________________

SCHOOL ACHIEVEMENTS

GRADE AVERAGE________ S.A.T.________ A.C.T.________

RANK IN CLASS: I RANKED_____________ IN A CLASS OF______________

HONORS AND/OR AWARDS:__________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

INVOLVEMENT IN SCHOOL AFFAIRS

LIST HIGH SCHOOL STUDENT ACTIVITIES YOU PARTICIPATED IN (example: Student

Government, Athletics, Clubs):

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

INVOLVEMENT IN COMMUNITY AFFAIRS

IF YOU ARE AN ACTIVE MEMBER OF A COMMUNITY ORGANIZATION, WHAT IS ITS NAME?

__________________________________________________________________________

IF YOU ARE AN ACTIVE MEMBER OF A CLUB OR SOCIETY IN A CHURCH OR SYNAGOGUE, WHAT IS ITS NAME?_________________________________________________

IF YOU DO VOLUNTEER WORK TO HELP PEOPLE, WHAT DO YOU DO? ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

PERSONS WRITING RECOMMENDATIONS

          NAME           ADDRESS                  OCCUPATION                     PHONE

1. ________________________________________________________________________________

2. ________________________________________________________________________________

3. ________________________________________________________________________________

**PLEASE ATTACH A SHORT ESSAY ANSWERING THE FOLLOWING QUESTION:
WHAT DOES THIS SCHOLARSHIP MEAN TO YOU?

THIS SCHOLARSHIP IS AVAILABLE 
TO HILLSIDE RESIDENTS ONLY

PLEASE RETURN BY 5/4/2001 TO:  Brian O’Malley Memorial
                                                                               Scholarship Fund
                                                                               P.O. Box 808
                                                                               HILLSIDE, ILLINOIS 60162