PETER SEPE MEMORIAL SCHOLARSHIP

Applicant: _________________________________________________________________

Address:  __________________________________________________________________

                        (Number)         (Street)                                     (Town)

Date of Birth: _______________________________________________________________

                        (Month)            (Day)               (Year)

Home Telephone #_____________________________Other Phone #_____________________

Name of High School from which you will graduate: ___________________________________

Class Rank: ___________ GPA: ______________ Date of Graduation: ___________________                              

College(s) to which you have applied:

Have you been formally accepted at any of the above? _________________________________

What major or course of study will you pursue? ______________________________________

List extra curricular activities/organizations in which you have been involved during your high school years. Use additional space if necessary.

Activity/Organization                             Years of involvement                Positions held

List all volunteer service within your school and community.

Program                       Length of time involved                         Description of Activity

ESSAY: What life lessons did you learn while participating in high school sports? (250 words)

Please return application with essay, high school transcript and a letter of recommendation from your coach to Mrs. Gempp in the Mt. Hope High School Guidance Office by January 12, 2007.