O’Grady – Brown Memorial Scholarship Fund, Inc.

Scholarship Application Form

P.O. Box 1024

Nyack, N.Y. 10960

Please Print or Type

Two recommendation letters are to be submitted with this application.

Name:                                                                                          Date of Birth:                                Age:              

Address:                                                                                                  Phone: (      )                                             

Parent(s)/guardian(s) Name:                                                                                                               

Local schools attended:                                                                                                                        

High School:                                                                     Graduation Date:                              

Intended Major:                                                                                             Misc.:                                                

Educational and career goals:                                                                                                                                 

Colleges applied to:                                                                                                                                                   

Colleges accepted by:                                                                                                                                               

Scholarships received or applied for:                                                                                                                       

Please explain your background and purposes in applying for this scholarship.

You may attach additional sheets as necessary.  Consider special interests, activities, awards,

service organizations, sports, work experience, etc.

If you feel you have financial need, state reasons why:                                                                                          

Date:                                            Signature:                                                                                                             

APPLICATION DEADLINE :         15 APRIL