MAIL TO:		THE AMERICAN LEGION
			DEPARTMENT OF NEW HAMPSHIRE
				25 CAPITOL ST RM. 431
				CONCORD NH 03301-6312
	ALBERT T. MARCOUX MEMORIAL SCHOLARSHIP									$1,000.00
Please provide the following information:
NAME
		(LAST)		(FIRST)		(MIDDLE INIT.)				(AGE)
ADDRESS ___________________________________________________________________________________________
		(STREET OR P.O. BOX)					(CITY, STATE, ZIP CODE)
TELEPHONE _________________________________					RESIDENT OF NEW HAMPSHIRE ______				YEARS
NAME OF PARENT OR GUARDIAN YOU LIVE WITH _________________________________________________________
EMPLOYER & EMPLOYMENT			FATHER
			MOTHER
TOTAL HOUSEHOLD INCOME BEFORE DEDUCTIONS $ _______________
NUMBER OF YOUNGER CHILDREN IN YOUR FAMILY ________
NUMBER OF FAMILY IN COLLEGE OR POST SECONDARY SCHOOL NEXT YEAR ___________
COLLEGE EXPENSES:					ANTICIPATED RESOURCES:
Tuition and Fees		$			Parents Contributions		$
Room and Board		$			Scholarship & Grants		$
Books and Supplies		$			Your Contribution		$
Personal		$			College Work Study		$
Travel/Commuting		$			Other (Specify)		$
Others		$			____________________________________
	TOTAL	$				TOTAL	$
** APPLICANT MUST SUBMIT THE FOLLOWING INFORMATION WITH THIS APPLICATION **
1.	A photo copy of your mother or father's American Legion or Auxiliary current membership card. In case of a
	deceased parent(s) membership at time of death must be certified by the Post Adjutant.
2.	Evidence of acceptance to an accredited four (4) year college or university leading to a Bachelors Degree
	in the field of education.
3.	Brief narrative of explanation of intended vocation to be pursued.
4.	A resume to include such information as educational background, all school and outside activities,
	need, and other information you feel is important.
5.	A transcript of high school grades for Junior and Senior years, showing at least a "B" average.
6.	At least two (2) letters of endorsement, (i.e.  Teachers, Principal or other prominent members
	of your community).
	WE CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE.
	Students Signature						Parent or Guardian Signature
		**  APPLICATION MUST BE POSTMARKED NO LATER THAN MAY 1st  **