The Edward A. Dillon Memorial Scholarship Fund, Inc. SCHOLARSHIP APPLICATION FORM

Applications for each non-renewable $1,000 Edward A. Dillon Memorial Scholarship will be reviewed and awarded by the EADMSF Scholarship Committee.

Please complete your application, including all documentation, and send to: The Edward A. Dillon Memorial Scholarship Fund, Inc. P.O. Box 7282 Buffalo Grove, IL 60089 Fax: (847) 205-1039

Please Print or Type:

Last Name: First: Middle:

Permanent Address: Street City State Zip Code

Student Home Phone: Cell Phone:

Student Email Address: Birth Date:

High School: Date of HS Graduation:

Attending College/University:

Parent Name(s):

Parent(s) Address: Street City State Zip Code

Student’s Signature: Date:

Applications accepted from April 1, 2014 to April 30, 2014 for 2014-2015 school year.Recipients will be notified by July 31, 2014.

Applicant must be a full-time college student.

A letter of recommendation from a community member (i.e., teacher, coach, mentor) must be submitted with the application in a sealed envelope.

The applicant must write and include an essay stating career and personal goals (500 words or less).

Eligibility requirements: