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Application / Students

Scholarship Chairman
Willie L Lewis CEC

For the Year 2009 & 2010

PERSONAL INFORMATION:

This Application must be in by December 27/2009 to Be consider for the February 28/2010 Scholarship.

Last Name:_____________________________

First:______________________________ 

Street Address:_________________________________________

City:_________________________ State: _____ Zip: _______ Phone: ____________

Alternate Phone: __________________  Social Security Number: _________________
E-mail: __________________  Date of Birth: _______________

EDUCATIONAL Eligibility INFORMATION:  YOU MUST BE ATTENDING A CULINARY SCHOOL AT THE TIME OF THE Scholarship AWARDS  Are you currently attending a culinary school? ______ If so, provide below
Name: _________________________ Enrollment Date: ________  Address: ________________________________________________  City: ____________________State:_________Zip:___________  Contact Name:______________________________ Contact's Phone: _______________  Your Major:____________________ Degree You Are Pursuing: ________ GPA: ___ 
Expected Date of Graduation:____________

Attending Full Time? Yes ( ) No ( )

If not in culinary school, have you applied? ________ When:_________________  Have you been accepted? _____

If "Yes", provide the details below 
School Name: __________________________________________  Address: ______________________________________________  Contact: ________________Contact's Phone: _____________
Expected Start Date:_______________________ 
Previous School(s) Attended:
Degrees Attained/Majors: Include High School and Graduation Dates  _______________________________________________     _______________________________________________    _______________________________________________      FINANCIAL INFORMATION: 
How much is your annual tuition?__________________________  How are you financing your education? (Be sure to identify the percentage of funding from each source.) 

___________ parents’ contribution
___________ scholarships
___________ work 
___________ personal loans
___________ government loans
___________ saving  other (explain) _____________________________________ EMPLOYMENT INFORMATION:  Are you currently employed? Yes ( ) No ( ) If yes, hours per week:__________ 
Work Experience: List dates, place, title and number of hours per week worked  Dates     Place                             Job Title                Hrs/Week  _____________________________________
_____________________________________
Describe extra-curricular activities (community service, athletics, clubs, etc.) you have been involved in, and note awards or special recognition you have received  _____________________________________
REFERENCES:  Your application MUST be accompanied by two letters of recommendation from a  supervisor, teacher, advisor or other culinary professional familiar with your skills. List your references below and include their letters with your application. If not included, your application is not complete.  Name__________________________________ Name__________________________________  Title_________________________________ Title_________________________________  Company_______________________________ Company_______________________________  Address_______________________________ Address_______________________________ 
City, State, Zip______________________
City, State, Zip______________________ 
Phone ( )_____________________________
Phone ( )_____________________________ 

To help us in our planning, please tell us how you learned of the

Application / Students   To the best of my knowledge, all of the information I have provided is accurate and true. I understand that by my signature below, I am authorizing my attending school to provide The Professional Chef Association of South Jersey WWW.PCASJ.com any necessary information to verify my attendance and the accuracy of this application.  I understand that this application does not in any way guarantee the receipt of a Scholarship. It is an application that can be accepted or denied at our option. If my application is accepted for consideration in writing, it does not in any way guarantee the receipt of a Scholarship. I agree that I abide by your final decision and that I have no recourse to contest it. 

Signature:_________________________________________

Date:____________________

Mail this form to:

Professional Chef Association of South Jersey
PO. Box 1003
Brigantine New Jersey 08203                      www.pcasj.com

Please complete the essay form to follow.    Professional Chef Association of South Jersey   John Carbone Scholarship Application Essay      

(Essay must be typed or neatly written and a minimum of 250 words telling us why the culinary field is one you wish to pursue and become a Chef and your goals in this field. Use additional pages if needed.                        2/28/2010

Executive Chef CEC

Willie L Lewis

President  ACF / PCASJ Chapter

609-703-9912

wlewis1799@aol.com

www.pcasj.com