Directions:
Print
out application and complete all questions.
Mail with any supporting documents to:
Ellen R. Kelly
Director pf Planning and Community Development
Village of Freeport
46 N. Ocean Avenue
Freeport, NY 11520
Tel: (516) 377-2203 Fax:(516) 377-2394
Name:
Email:
Address:
City:
State:
Zip:
Social
Security Number:
Home
Phone:
Best time to call:
Business
Phone:
Best time to call:
I.
Please complete the following:
College
on Long Island that you are attending
in the fall of 2004:
Area of
concentration-major course of study:
Number
of credits currently attained:
Grade
point average:
Are you
a matriculated student?
Yes
No
Schools
attended:
Names
Dates Diploma/Degrees Completed
II.
Please describe the following:
Community
or extracurricular activities.
Special
honors or achievements.
Describe
the basis for your financial need and
how this scholarship will make a difference
in your ability to continue your education.
III.
Write an essay
describing your career goals including why
you are pursuing your education and what you
are seeking to accomplish both in the near
future and long term.
IV.
Send
a sealed official copy of your most recent
transcript to the address indicated below
I
AFFIRM THAT THE INFORMATION SUBMITTED ON THIS
FORM AND ANY ATTACHMENTS ARE ACCURATE
TO THE BEST OF MY KNOWLEDGE.
Yes
No
Date
V. Signature
of Applicant:
Print
out and mail completed application to:
WEDLI
Scholarship Committee Women
Economic Developers of LI
Ellen R. Kelly
Director pf Planning and Community Development
Village of Freeport
46 N. Ocean Avenue
Freeport, NY 11520
Tel: (516) 377-2203 | Fax:(516) 377-2394
NOTE:
APPLICATIONS NOT ACCOMPANIED BY THE APPROPRIATE
ATTACHMENTS, NUMBERS II THROUGH IV ABOVE,
WILL BE CONSIDERED INCOMPLETE AND WILL NOT
BE CONSIDERED FOR AWARDS.
Deadline:
May 2, 2005
Women Economic Developers of Long Island Michele A. Pincus,
Esq.
Lazer, Aptheker, Rosella & Yedid, P.C.
225 Old Country Road
Melville, NY 11747
