Application must be received by April 25, 2008 for consideration

Please type or print all information. Additional pages may be attached as needed. The scholarship committee considers all information strictly confidential. Please note that the scholarship committee will not consider incomplete applications.

APPLICANT INFORMATION

Applicant’s Name: ______________________________________________________________

Last First Middle Initial

Mailing Address: _______________________________________________________________

Home Phone: ( ) _____ - _________

Date of Birth: Social Security Number: _______________________

Number of Brothers or Sisters: ______________

ACADEMIC INFORMATION

Name of Institution you will attend: ________________________________________________

Field of Study You Intend to Pursue: _______________________________________________

Current School: Current Grade Point Average: ________

Honors and Awards you may have received: _________________________________________

_____________________________________________________________________________

List your participation in extracurricular, community, and/or volunteer activities: ___________

_____________________________________________________________________________

Personal Information

Places and Dates of Employment: ____________________________________________

_______________________________________________________________________

Are there any special circumstances concerning family that create any special needs which you want taken into consideration? If so, please list: _______________________

_______________________________________________________________________

Briefly explain why you are pursuing your choice of study: _______________________

_______________________________________________________________________

Date: _________________ ___________________________________

Signature of Applicant

Date: _________________ ___________________________________

Signature of Parent or Guardian

Please send all required information, this form, and any separate letters of recommendation by April 25, 2008 to:

Thomas Township Fire Department

8215 Shields Drive

Saginaw, Michigan 48609

For further information contact Josh Mosher at

(989) 781-4141 or

E-mail: ttfdinsp41@aol.com

www.thomastwp.org