Applicant Name: 

Prefix	First	MI	Last	Suffix
Mr. Mrs. Miss Ms.

Street Address:
 

Address 2 (optional):
 

City:  

State:   Zip Code:  

County:  

Home Phone Number:  

Email address:  

Date of Birth:

High School you attended:

If married, name of spouse: 
 

Is spouse employed? Yes No

If yes, name of employer:

  Annual earnings of spouse:  

List any children you have (names and ages): 
 

Post-Secondary Information

List all colleges, universities, graduate and professional schools previously attended on a full-time basis. Include the law school you are currently attending. Include the name of the institution, the dates you attended, the degree earned (if any) and your major:

Parental Information

Father's Name (if supporting applicant): 
 

Father's Address:
 

Father's Occupation:
 

Father's Earnings (if supporting applicant):
 

Mother's Name (if supporting applicant): 
 

Mother's Address:
 

Mother's Occupation:
 

Mother's Earnings (if supporting applicant):
 

If you are being supported by your parents, list other members of your family who are living at home. Include name, relationship and occupation, if applicable:
 

What are your ties to Berks County? 
 

Employment:

List your recent places of employment, including summer employment or military service:

Most recent employer:

Dates:
 

Employer:
 

Position:
 

Reason for leaving:
 

Next employer:

Dates:
 

Employer:
 

Position:
 

Reason for leaving:
 

Next employer:

Dates:
 

Employer:
 

Position:
 

Reason for leaving:
 

Next employer:

Dates:
 

Employer:
 

Position:
 

Reason for leaving:
 

Financial Information

What is the total cost of the second year of law school, including tuition, room, board and books?
 

What is the amount of money you will contribute to your education during your second year, not including other scholarships you are receiving?
 

Who will be financially responsible for your educational expenses?
 

Have you received or do you anticipate receiving any scholarships, loans or financial awards? If so, please indicate which ones and the amount of each:

Additional Information

Have you ever been subject to disciplinary action for any reason in any of the colleges, universities, graduate or professional schools you have attended?
Yes No 

If the answer to this question is "Yes," please explain:.
 

Have you ever been convicted of a crime other than a minor traffic violation?
Yes No
 

If the answer to this question is "Yes," please give dates and complete details:
 

Please use this space to provide any additional information that you believe the screening or selection committee should know.

Please attach a one page essay that describes why you chose a law career, how you hope to benefit the community through your career and your future career goals:
 

Please attach your first reference letter:
 

Please attach your second reference letter:
 

Please attach your law school transcript:
 

Please attach a recommendation from a professor at the law school you are attending:
 

How did you hear about the Community Foundation?

Note: Berks County Community Foundation employees, board members and/or committee members are not eligible to apply for or receive a scholarship offered by Berks County Community Foundation, nor are their immediate family members. However, immediate family members are eligible to be nominated and recognized as the recipient of a scholarship, but without the financial award of the scholarship. Immediate families include spouses, children, stepchildren, grandchildren, stepgrandchildren. The ineligibility period for Berks County Community Foundation board members or employees extends five years after board service or employment terminates. The ineligibility period for committee members who are not Berks County Community Foundation staff or board is in effect only during their term of service.