EmailMeForm
Unique ID
Personal Information
Name
*
First
MI
Last
Email
*
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Cell Phone
*
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-
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-
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Parent/Guardian Name
*
Parent/Guardian Email
*
Parent Cell Phone
*
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Lodge Member information
Lodge Member Name
*
Relationship to LodgeMember
*
Community Service
Community Service Hours
*
Detail your minimum 25 hours of community service. Include information on what you did, for how long and the name of the organizations you served.
School Information
High School
*
Eastchester High School
Tuckahoe High School
Bronxville High School
Iona Prep
The Ursuline School
Other
Italian Level
*
Did not take Italian
Italian 4
Italian 4 Honors
Italian 5
Italian 5 Honors
AP Italian
Other
A foreign language is NOT a requirement for this scholarship
College
*
Major
*
Guidance Information
Guidance Counselor
*
Guidance Counselor Email
*
Presentation
See instructions above for slideshow requirements
Slideshow link
*
include a PUBLIC link to your slideshow
Disclosure
Checkbox
*
By signing below and submitting this application I certify that the information provided in the application is truthful and accurate, and has been completed solely by the applicant.