Application Form

for the Michael Lynch Memorial Foundation Scholarship

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Application to be completed by the applicant and submitted to:

The Michael Lynch Memorial Foundation
P.O. Box 132, Bronx, New York 10465

Deadline for submission: April 30^th

1.) Name
2.) Address
3.) Phone
4.) E-mail
5.) Qualify	Please provide below the name of parent/guardian who: (a) is currently or was previously employed by the City of New York as a firefighter (b) passed away in a fire in New York City (c) was lost in the attack on the World Trade Center on September 11, 2001 (d) passed away in any other natural or national disaster Name: ____________________________________________________
6.) Institution	A) At what college do you plan to be enrolled in the coming academic year? Accredited Institution Name: ___________________________________________________ B.) If you have not yet decided where you will attend college, please provide us with the names of colleges to which you are applying and to which you have been admitted. If your decision depends on the availability of financial aid or scholarship funds, please indicate such circumstances below. ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________
7.) Other Funds	Are you applying for or receiving any other scholarships? If yes, please describe
8.) Attach	The following information will be required to complete the application: Transcript from high school SAT scores (or ACT scores) List (including grades) of any college level courses that you have already completed A minimum of two letters of recommendation from high school teachers, coaches, guidance counselors, etc who will be submitting letters on your behalf (If other persons other than teachers will be submitting letters on your behalf, at least one must be from a teacher). If any person writing on your behalf is currently or previously employed by the City of New York as a firefighter, please indicate that next to his or her name. Copy of your parent's income tax report for the past two years (If you filed your own income tax report, please also submit). An essay of at least one page, single spaced, addressing your college and career goals and how a grant from the MLMF could help you achieve those goals.
9.) Comments	If you would like to take the opportunity to discuss or explain any element of your transcript, please include with this application a brief statement, not to exceed one typewritten double-spaced page

The Michael Lynch Memorial Scholarship Program is a publicly endowed fund established to provide scholarships to relatives of (i) New York City firefighters, (ii) victims of fires in New York City, (iii) victims of the September 11, 2001 World Trade Center attacks and (iv) victims of other disasters, and others as the Directors of the Foundation may, in their discretion, designate. Students in any one of the above mentioned categories who are about to commence a college education or who are currently in the process of obtaining an undergraduate degree are eligible to apply. Selection of Michael Lynch Memorial Scholarship recipients is, based on objective, non-discriminatory criteria without regard to race, sex, religion, national origin, sexual orientation or ethnicity.