Meriden Amateur Radio Club Inc.
P.O. Box 553
Meriden, CT 06451
www.W1NRG.com
Scholarship@w1nrg.com

This application may be filled out electronically or you may print the form from The Frank Darmofalski Scholarship page, fill it out, and mail or email it to the address above.

In addition to the completed application, the applicant must submit:

• A written essay of 250 words (minimum) on why they selected their program of study and what they plan to do with it upon graduation/program completion.
• High school transcripts.

Letters of recommendation are optional. Completed applications must be received no later than April 14.

Please enable JavaScript in your browser to complete this form.

Date

Date submitted.

Name *

First

Middle

Last

Street Address *

City, State, ZIP *

Phone *

Email *

High schools attended *

Please list all high schools you have attended, most recent first.

Date of graduation *

Class rank *

Please give your class rank in the form ___ of ___, e.g., "10th of 270."

Grade Point Average *

What is your grade point average, e.g., "3.7 out of 4.0"

List high school distinctions and/or honors

List extracurricular and community service activities

List hobbies or special interests

Do you have an amateur (ham) radio license? (copy) *ChooseYesNo

If yes, what is your call sign?

Do any family members have an amateur (ham) radio license? *ChooseYesNo

If yes, what is their call sign?

Are you or any family member a member of the Meriden Amateur Radio Club? *ChooseYesNo

If yes, what are these members' names?

College/university where you have been accepted or enrolled *

Please add the name and physical address of the college or university.

Major/field of study *

Please list your intended major.

Parent or guardian 1 *

First

Last

This person is *

• My mother
• My father
• Other
• Deceased

Check all that apply.

Parent or guardian 2

First

Last

This person is

• My mother
• My father
• Other
• Deceased

Check all that apply.

Estimated annual gross income of parent(s)/guardian *

Number of siblings *

Number of siblings in college *

Do you presently have a job? *ChooseYesNo

If yes, where?

This includes tuition, rent, dorm fees, food, utilities, etc.

What percentage of your educational expenses are to be paid by your parent(s)/guardian(s)?

Selected Value: 0

What percentage of your educational expenses are to be paid by scholarships and grants?

Selected Value: 0

What percentage of your educational expenses are to be paid by yourself?

Selected Value: 0

What percentage of your educational expenses are to be paid by loans?

Selected Value: 0

What do you estimate your tuition and board cost to be for the first year? *

What do you estimate your books cost to be for the first year? *

What do you estimate your miscellaneous cost to be for the first year? *

Your signature *

First

Middle

Last

I hereby attest that I understand the scholarship award terms and that the foregoing information provided by me is true to the best of my knowledge. If I am granted the scholarship by MARC Inc. I will permit my name to be used for publicity releases to further the aims and purposes of MARC Inc.

Parent or guardian signature *

First

Last

Submit