ALDEN KINDRED OF AMERICA, INC.

DONNELL B. YOUNG SCHOLARSHIP APPLICATION

use your web browser to print this application and the requirements

NAME OF APPLICANT:

 _____________________________________________________________

MAILING ADDRESS (Include any PO Box)

________________________________________________

TOWN/CITY: _________________________ STATE: _______________

 ZIP CODE: _____________

PHONE NUMBER WHERE YOU CAN NORMALLY BE REACHED: ____________________________

HIGH SCHOOL: ________________________________

YEAR OF GRADUATION_______________

FIELD OF STUDY (If known) __________________________________________________________

ADDRESS OF COLLEGE: _____________________________________________________________

I am descended from: ____________________________, son or daughter of John Alden.

Please list after-school activities, hobbies, clubs, organizations or volunteer organizations or community service activities you have been involved with. Continue on a separate sheet if necessary.

Please list two references that we may contact. One must be from your school and a second must be a personal reference. Include their addresses and their phone numbers.

1. _______________________________________________________________

2. _______________________________________________________________

_________________________________________________________________

(Signature of Applicant) (Date)

FOR SCHOLARSHIP COMMITTEE USE ONLY

_____ REFERENCES OK

_____ RESEARCH PAPER OK

_____ TRANSCRIPT OK