APPLICATION FOR THE THOMAS F. BLACK, JR. MEMORIAL SCHOLARSHIP OF THE RHODE ISLAND BAR FOUNDATION

  

Please print out and complete the following scholarship application form. Once complete, you may fax it to 401.421.2703 or mail it to us at:  RI Bar Foundation, 115 Cedar St., Providence, RI, 02903.

    
 
1.  Full Name

 

       2.  Present Mailing Address
 

(Last)

(First)

(Middle)

    

(Please be sure that this name is the same on all applications, LSDAS and FAFSA materials)

   Street  
    City  
    State & Zip Code  
Social Security Number:   Telephone  
    Email  
   
Date of Birth:   3.  Permanent Mailing Address
        (Address where you can be contacted at any time)
Place of Birth:       
        After what date should we use this address?
Citizenship:    
     
Date your RHODE ISLAND Residency began:   Street  
    City  
  State & Zip Code  
  Telephone  
  Email  
   
4.  List name and location of high schools attended and year of graduation.
 

 

 
5.  List all colleges, universities, graduate and professional schools attended on a full-time basis.
 

School

Dates of Attendance

Degree 

Date

Major

Rank and Class Size
           
           
           
 
6.  List scholastic or academic honors including scholarships, fellowships, prizes, honor societies, etc.
 

 

 
7.  List and briefly describe three non-academic activities which have been important to you.
 

 

 
8.  List Law Schools to which you have applied as a full-time student:
 

 

 
9.  Have you completed a FAFSA or other Financial Aid Form:______________________________           
    (A copy of the completed SAR Report is required)

 
10.  2006 Annual Income for you and your parents______________________________________            
    (please attach copies of yours and your parents' tax returns)

 
11.  List names and addresses of your parents:
 
Father Mother
Name   Name  
Street   Street  
City   City  
State/Zip Code   State/Zip Code  
Telephone   Telephone  
Email   Email  
 
12.  Were you employed during the academic year as an undergraduate?______________ Positions held _______________
______________________________________________________________________________________________________
  
No. of hours per week:  Fr. Yr._______________ Soph. Yr. _____________ Jr. Yr. ______________  Sr. Yr. _____________
 
13.  State your last four positions of full-time employment.
 
  Dates   Employer Position Reason for Leaving
       
       
       
       
       
 
  YES NO
14.  Has your academic career been interrupted for one or more terms?
15.  In an academic setting, have you been subject to disciplinary sanctions, or are charges pending?
16.  Have you been convicted* of a felony?
17.  Have you been convicted* of a misdemeanor (except drunkennes, simple assault, speeding, minor traffic violations, affray, or disturbing the peace) within the last five years?
18.  Are any charges pending which, if you were to be convicted, would require your answer to either of the two previous questions to be "yes"?
      If any answers are "yes", please give details on reverse side of this sheet.
 
     *without the conviction later being vacated

 
19.  List all dates you have taken or will take the LSAT: _______________________________________________________________
20.  Date(s) registered with LSDAS: ________________________________________________________________________________
21.  Have you ever applied for admission to a Law School in a prior year or ever attended Law School?  If so, please explain:_______
_______________________________________________________________________________________________________________
 
22  List names of the two people submitting recommendations:
Name Name
Street   Street  
City   City  
State/Zip Code   State/Zip Code  
Telephone   Telephone  
Email   Email  
  
NOTE:  This application and supporting material must be received by March 9th, 2007. After the due date, please inform the Bar Foundation of any supplemental information you recieve from law schools regarding acceptance and/or financial aid packages awarded to you.
Send Materials to:  Rhode Island Bar Foundation, 115 Cedar Street, Providence, RI  02903 
Telephone:(401) 421-6541    Email: gcaldwell@ribar.com 
 
If you need additional space, please attach. 
 
I hereby certify that the information I have provided on this application form and in any attached materials is true and complete.
Signature: ________________________________________________________    Date __________________



  • Reminder -- the following items are needed to complete your application:

    • Personal Statement
    • Official Transcripts
    • SAR report from FAFSA
    • Copies of yours and your parents' tax returns
    • Two letters fo recommendations

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