HENRY J. MUNGER AND MARIE MUNGER SCHOLARSHIP FUND


David P. Zuber, Trustee
E-mail: davzcpa@aol.com
J. Thomas Brennan, Trustee
E-mail: tb@tbnet.net

550 East Main Street #32
Branford, CT 06405
Telephone (203) 483-1180
Fax (203) 488-0347

APPLICATION FORM

RETURN COMPLETED FORM, MARKED "CONFIDENTIAL",
WITH A COPY OF YOUR FEDERAL STUDENT AID REPORT ("SAR"), A COPY OF
YOUR SCHOOL TRANSCRIPT(S), AND YOUR SAT TEST SCORES IF THEY DO
NOT APPEAR ON YOUR HIGH SCHOOL TRANSCRIPT.

Name:

School attended in school year ending in 2010:

Your age:

Telephone number:

E-mail address:

Mailing address:

Additional addresses in last four years:




Has your permanent residence been in either Guilford, Madison or Clinton during the four years you attended high school?


What is your approximate class rank?

What were your most recent SAT scores?

What advance placement tests will you have taken prior to beginning your college studies?

What mathematics courses are or have you taken?







What science courses are or have you taken?






Who are the people who reside in the same household with you and what are their occupations?



Are there any other people not living in the same household with you to whom one or more of your parents contributes financial support? If so, who are they and are they students?





Is there any reason to believe that your father and mother's combined adjusted gross income for 2011 will be more than 10% less than it was in 2010?



Was any of your parent's income from self employment?

Is either of your parents retired or working other than full time? If yes, please explain.



>From your SAR, what is your
EFC (Expected Family Contribution)?



What college or university do you plan to attend?

What is the combined cost for 2011-2012 of tuition, student fees, room and meals at that college or university?

What financial aid has been awarded to you by the college or university you plan to attend?



What do you want to study while in college?



How does your mother presently earn income and what occupations has she had in the past?



How does your father presently earn income and what occupations has he had in the past?



How do you expect to earn your livelihood?





Reason(s) why you selected the college you plan to attend:







What activities, clubs and/or sports did you participate in while in high school?







Are there any other things which you would like to bring to the attention of the Trustees about yourself or your family?







Date: _______________________


Date: _______________________


Date: _______________________

_______________________________
Applicant

_______________________________
Parent

_______________________________
Parent


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