SLOVAK CATHOLIC SOKOL GRADE SCHOOL GRANT APPLICATION

Group #  Assembly/Wreath #
Name
Address
City  State Zip Code
Date of Birth Current Age
Home Phone  School Phone
S.C.S. Insurance Certificate # Face Amount
S.C.S. Insurance Certificate # Face Amount
S.C.S. Insurance Certificate # Face Amount
Father's Name Are you a member? (Check if Y)
Mother's Name Are you a member? (Check if Y)
Parent's S.C.S. Insurance Certificate # Face Amount
Parent's S.C.S. Insurance Certificate # Face Amount
Are you a previous Slovak Catholic Sokol Scholarship Recipient?   (Check if Y)
If yes, what year?

SCHOOL VERIFICATION  (to be completed by Grade School Principal)

I,

 Principal of 

(Principal's Signature)

(Name of School)
Catholic Grade School, verify that

 is a student at the

(Name of Student)
above school and will be attending Grade in the 2011-2012 school year.
Are you currently participating in Slovak Catholic Sokol Activities?   (Check if Y)

Deadline for receipt of this application is March 31, 2011. Return completed application to:

Slovak Catholic Sokol, Grade School Grant

205 Madison St., P.O. Box 899, Passaic, NJ 07055