Please submit this completed online form by April 14, 2017, along with mailing in the following, to the return address below:
1. Academic record through the 1st semester of the senior year. (Unofficial will suffice.)
2. Copy of SAT Scores. (Unofficial will suffice.)
3. Letter of recommendation from principal or guidance counselor.
4. Essay on “Why I Want a College Education” (100 words or less).
5. Parent/Guardian Application completed.

Return Address MNYCA, 492C Cedar Lane #535, Teaneck, NJ 07666
Questions? Please direct any questions to MNYCA office via phone at 201-489-8096 or
via email to Patty Paletto at patty.paletto@mnyca.org.

 * you can also download this form and mail it in…Download Student Application (pdf)


Student Application Form

1) Your Name Date

2) Home Address City
State Zip Code

Email

3)Date of Birth Phone Number

4) Name and address of high school your are currently attending

Address City
State Zip Code

5) Anticipated graduation date

6) Where have you completed applications/applied for college admission?

Accepted? (required)YesNoDon't Know

Accepted? (required)YesNoDon't Know

Accepted? (required)YesNoDon't Know

Accepted? (required)YesNoDon't Know

7) List any academic honors your received.

8) List clubs and/or organizations you have joined, in and out of school. If you held or now hold any office in one of these groups, please state the title of this office.

9) Additional information you feel might have bearing on this application

I, agree to hereby apply for the Helene M. Senker Memorial Scholarship Award for 2017 being awarded by the Metropolitan New York Coatings Association, Inc.,