The Stanley Jay Kurta Charitable Trust

We wish to thank you for your interest in applying for this scholarship. Our good friend Jay Kurta is no longer with us and we wanted to keep him in our minds and in the minds of others. Jay was an exceptional person, generous, well educated and a very good friend to all that knew him. Jay was a long-standing member of The Club National in Nashua, New Hampshire.

The Stanley Jay Kurta Charitable Trust was created to honor and preserve Jay’s memory.

Eligibility Requirements

Applicant must be a High School graduate or have an equivalent GED.
Applicant must be attending or plan on attending an accredited College or University.
Applicant must be a child, grandchild, stepchild, step-grandchild, or adopted child of an active member of The Club National in good standing.
This award is for undergraduate study only.

Application Process

It is the applicant's responsibilty to complete this application for scholarship in its entirety and shall include all required documentation including checklist.
A letter from the Club National member attesting to the applicant's eligibility and member number.
Name of College or University with a copy of letter of admission.
Two (2) letters of recommendation from individuals not related to the applicant.
All applications must be postmarked no later than April 30, 2010.
All applications received are considered confidential and are reviewed only by the Members of the Board of Trustees for The Stanley Jay Kurta Charitable Trust.
All questions must be directed to: jaykurta@gmail.com

Selection of Recipients

Selection of recipients will be based on the combination of transcripts, ACT/SAT test scores, extracurricular activities, community involvement and work experience.
All applicants agree to accept the decisions of the deciding board of The Stanley Jay Kurta Charitable Trust.

Award Details

The recipient will receive a $1,000.00 scholarship that will be paid directly to the College or University on behalf of the student.
This award must be applied to: tuition, books, fees, or on-campus room and board only.
Recipient and legal guardian agrees to allow The Stanley Jay Kurta Charitable Trust to use any photographic or electronic image taken of the award recipient for public relation and marketing purposes.

The Stanley Jay Kurta Charitable Trust Scholarship Application

Personal Information

Student Name Ms./Mr. __________________________________________________ (circle one) First Middle Last

Address ____________________________________________________________

City State Zip Code

Home Phone (_____)-(_____)-(_______) E-Mail __________________________ Optional

High School __________________________________________________________ School Name State

Year of High School Graduation _______________

College, if currently attending ____________________________________________ School Name State Year of expected College Graduation ______________ Club National Member’s Name___________________________________________ Club National Member’s Number_________________________________________ Relationship to Applicant _______________________________________________

Academic Information

The school I plan to attend is a: (please check) ( ) 4 Year College/University

( ) 2 Year College Name of school you plan to attend ________________________________________

Field of Study ______________________________________________________

Attach a copy of your high school and/or college transcripts.

Attach a copy of your SAT/ACT scores.

Attach a copy of the Letter of Admission from the school you plan to attend.

Activities

Attach a detailed list of all school and community activities in which you have participated. Be sure to include the year of involvement, your role in each activity, and any honors achieved. Some examples would be: Athletic involvement in both school and citywide, extracurricular activities such as drama, band, social committees, etc., and community services such as Church, scouts, etc.

Personal

Attach a written essay, 300 words or less, about “Who you are and what you want to accomplish”.

Attach a letter from the Club National Member attesting to your eligibility.

Attach two (2) Letters of Recommendation from individuals not related to you.

Please mail your completed application as well as all required documentation and letters, postmarked no later than April 30, 2010, to:

Mr. Carl Jean c/o Greenerd Press & Machine Co., Inc. 41 Crown St. Nashua NH 03060

I certify that all information provided within this scholarship application is true and accurate. The Stanley Jay Kurta Charitable Trust is hereby authorized to verify any information contained in this application. I understand that any falsification or misrepresentation will result in disqualification.

Applicant’s Signature _________________________________________Date______

Member’s Signature __________________________________________Date______