MAX E. JONES

MEMORIAL SCHOLARSHIP

APPLICATION FORM

NAME___________________________________________________SSN________________________

CAMPUS ADDRESS/PHONE___________________________________________________________

NO. OF HOURS EARNED___________ (min. 64) CUM. G.P.A.__________(min. 2.5)

RECORD OF BOY'S CLUB ACTIVITIES (or with other youth‑serving agency)

I understand that in addition to the above requirements, I will be enrolled in both semesters of the

2007-2008 academic year. Should I not be a student in both semesters, I will forfeit the scholarship for

one or both semesters.

__________________________________

Signature

Deadline For Application: DECEMBER 17, 2006