CCA 2022 Student Scholarship Application Form
1. Personal Information
Name: Date of birth:
Home Street Address: Cell Phone: Email:
Mailing address:
Name of school now/previously attended:
Parent’s Name: Parent’s Address: Phone:
Name of institution which you plan to attend next year: Yr: Fr So Jr Sr (circle)
Have you been accepted? Expected graduation year:
Please state your educational/career goals:
Please list any other factors in support of this application which you may deem appropriate: (Honors or awards received, interests and activities, club memberships, civic activities, etc.)
II. Financial Information
Expected annual cost for: Name of school:
Tuition and fees $
Room and Board $
Transportation $
Total expected annual costs: $
Expected amount of financial aid: $
personal and family contribution: $
Scholarships, grants, awards, work study, etc $
Total personal/family, financial aid,other $
Please list any factors pertaining to your financial need of which you would like the committee to be aware
(e.g. other family members presently attending college, temporary unemployment of a parent, disability, changed circumstances, etc)
Applicant’s Signature: ________________________________________Date:_______________________
Please return your completed typed application (if using more than one page to reply – please put your last name at the top of each page) with a copy of the most up-to-date transcript of your grades NOT LATER THAN MAY 31, 2022 TO:
Email: subject line: 2022 CCA Scholarship your name at scholarships@cataumetca.org
or mail to: CCA SCHOLARSHIP COMMITTEE
P.O. BOX 277
CATAUMET, MA 02534-0277