NOTRE DAME HIGH SCHOOL

NOTRE DAME HIGH SCHOOL Member of the Middle States Association of Colleges and Secondary Schools 3417 Church Road, Easton, PA 18045 610 868-1431 Fax 610 868-6710 www.ndcrusaders.org

Personal Data Form – Scholarships/Internships for Underclassman STUDENT NAME_____________________________________________

2017-18 GRADE________________

STUDENT HOME ADDRESS______________________________________________________________________ CITY_________________________________________

STATE_____________ ZIP CODE______________

PARISH_________________________________________

PASTOR___________________________________

CURRENT GPA___________________________(minimum requirement determined by specific scholarship) EXTRA-CURRICULAR ACTIVITES AT ND/CURRENT SCHOOL: (CLUBS/SPORTS/ECT.): ______________________________________________ __________________________________________ ______________________________________________

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EMPLOYER INFORMATION (IF APPLICABLE): ______________________________________________ EMPLOYER

__________________________ CITY/STATE

ACTIVITIES PERFORMED WITHIN COMMUNITY: ______________________________________________

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HONORS/AWARDS/RECOGNITIONS: ______________________________________________

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____________ HRS/WEEK

PLEASE SELECT SCHOLARSHIPS/INTERNSHIPS BEING APPLIED FOR WITH THIS FORM: _____ Christopher Meddaugh Scholarship

_____ Jeff Dailey Scholarship

_____ Bishop Thompson Scholarship

_____ St. Luke’s Internship/Scholarship

_____ John Reichl Scholarship

_____ Stabler Foundation Scholarship

_____ Buesing Business Internship/Scholarship

_____ Our Lady of Lebanon Church Scholarship

_____ Above the Best – Class of 1964 Scholarship

_______________________________________________ Student Signature

_____________________________________ Parent/Guardian Signature

______________ Date

The information above has been verified by the Guidance Department and/or school administration. __________________________________________ Guidance/Administrator Signature

_________________________ Date