Bob Fish Memorial Scholarship & RIBA Family Scholarship

Name: *

Date of Birth: *

Email: *

Phone (Home):

Name of college and your graduating year: *

Major:

Does a member of your immediate family work at a RI radio or TV station?

Yes

No

If so, please give their name and relation to you, and their employer.

Academic Honors:

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Home Address

Street: * City: * State: * Select Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: *

School Address

Street: * City: * State: * Select Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: *

Mother and/or Father's Name(s):

Extra-Curricular Activities: *

• Describe school, business, community or other outside activities that you are involved in, past or present.
• List all positions held as well as how much time you invested in your activities.

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NARRATIVE

Submit a brief narrative describing yourself including the following points: (maximum 250 words)

1. Your reasons for seeking a RIBA scholarship
2. A family member, friend, colleague or educator who has influenced you in a significant way
3. Your long-range goals and aspirations
4. The importance of free, over-the-air broadcasting in today's society.

Narrative: * Total word count: 0 words. Words left: 250

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REFERENCES

Please indicate one academic and one personal reference that RIBA may contact:

Academic Reference

Name: * Relationship: * Phone: *

Personal Reference

Name: * Relationship: * Phone: *

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By filling in my name below I acknowledge that the information contained herein is true and accurate and I have not in any way misrepresented any information.

Applicant Signature: *

All recipients of the Bob Fish Memorial Scholarship will be required to sign and submit a W-9 prior to check being released. Recipients of the Bob Fish Memorial Scholarship will be presented with the award at a scholarship breakfast.