|
Sponsored by The Brockton Democratic City Committee
Name: ___________________________________ Date of Birth: __________________ Address: _______________________________________________________________ Telephone: _______________________Place of Birth: _________________________ Name of BDCC Committee sponsor: ________________________________________ Number of Dependents (if any): ____________ Ages? _________________________ Name of College where you are accepted or enrolled: ____________________________ What Degree program are you in: __________________________________________ How will you finance your education? (Check all that apply): Yourself: ___________ Parents / Relatives / Friends: _____________ Student Loans: ____________ Grants: _____________ Scholarships: ______________ Other (specify): ________________________________________________________
By signing the below I certify that, to the best of
my knowledge, the above information is true and I give permission for the
Brockton Democratic City Committee and Scholarship Committee to use my
name and image for press releases to announce scholarship award winners. Signature of Applicant: __________________________________ Date: _____________ Remember! Applicant must be a registered Democrat voter in the City of Brockton to be eligible.
|