2264 Silas Deane Highway
Rocky Hill, CT 06067
P: 860-258-7633
F: 860-258-7637

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To apply for a scholarship online, fill out the form below, then press the "Submit application" button at the bottom of the page.
Fields marked with a * are required.

*Last Name:

*First Name: MI:
*Address:
*Social Security    
*City:
*State: *Zip:
Resident Since:        
*Telephone:
Date of Birth: Age:
*Email:
       
School Now Attending:
Graduation Date:    
Town Entrance Date    
State Period Attended    
Name of Parents or Guardians:
       
Address:
       
City:
State: Zip:
Fathers Occupation and Employer:
Is his employer a member of the Rocky Hill Chamber of Commerce? Yes No
Mother's Occupation & Employer:
Is her employer a member of the Rocky Hill Chamber of Commerce? Yes No

Sisters/Brothers presently in school or college:

Name/Age School/College Year
Where do you rank in your class? (numbers only)
GPA Combined SAT Score Math Verbal

A. Please list all school activities (clubs, organizations, athletic teams, student government, etc.) in which you have actively participated, particularly positions of leadership.  Also, list activities that you are actively engaged in outside of school and at school (community, club, organizations, work, campus-based activities, etc.)  Why do you find these rewarding?

B. List any scholastic achievements or recognition awards.  Also indicate any special skills, attributes or special interests not previously listed.
What are your choices for college?
(Name/Location)
Have you been
accepted?
Estimated annual expenses
for college (books, tuition,
board, room, etc.)
1. Yes No
2. Yes No
3. Yes No
Intended academic major?
Why did you select these schools and how do they relate to your career goals? Please explain in detail your major interest, how your career will impact local or global business, and why you should be selected for the award:
Have you had any work experience (including community or volunteer work)? If yes, list employers/supervisors, occupations/duties and dates employed:
Employer/Supervisor
Duties
Dates Employed:
1.
2.
3.
How much have you been able to save toward college expenses?:
Do you intend to work while attending college? Yes No
If yes, please list the type of job, duties and hours you intend to apply for:
Why do you feel you should be selected for this award?
In your own words please describe what you feel the role of the Chamber of Commerce should be in a community and suggest some programs that would benefit its members:
Do you feel it would be helpful for the selection committee to be aware of any special family or personal circumstances? If so, please explain:
 

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