Fundación José Jaime Pierluisi

APPLICATION FORM

JOSE JAIME PIERLUISI SCHOLARSHIP

(Please print and return by mail or fax))

I. GENERAL INFORMATION

NAME _____________________________________________________________________________________
RESIDENTIAL ADDRESS_______________________________________________________________________
__________________________________________________________________________________________
POSTAL ADDRESS___________________________________________________________________________
__________________________________________________________________________________________
HOME PHONE NUMBER________________________ WORK PHONE NUMBER________________________
EMAIL_________________________________
DATE OF BIRTH_______________________________PLACE OF BIRTH _____________________________
ARE YOU DOMICILED IN PUERTO RICO? YES__________ NO_________

II. EDUCATION

	NAME	DATES FROM - TO	DEGREE	MAJOR	GPA
HIGH SCHOOL
COLLEGE/ UNIVERSITY
OTHER SCHOOLS

III. WORK EXPERIENCE (Start with most recent job and include summer jobs)

NAME & ADDRESS OF FIRM	TITLE	DATES FROM - TO	NAME/TEL. OF SUPERVISOR MO./YEAR STARTED	MO./SALARY INITIAL/END

CAN WE ASK FOR REFERENCES FROM THE ABOVE LIST? YES_____ NO______

IV. REFERENCES
Please indicate names of one university professor and two business/community reference:

NAME	POSITION	ADDRESS/TELEPHONE

V. OTHER INFORMATION

1) Other special courses or training taken:________________________________________________________
__________________________________________________________________________________________

2) Professional Licences: _____________________ ________________ _________________

3) Scholarship previously granted:

Scholarship Program	Dates From - To	Sponsored by

4) Admitted to university for graduate study? YES______ NO______

University	Location	Faculty

5) Have you received any financial aid from the university to which you are admitted? YES_______NO_______
Explain:__________________________________________________________________________________
________________________________________________________________________________________

6) Have you taken the GMAT? YES_______ NO_______

7) Honors and Memberships in Educational, Civic and Professional Societies:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

8) Language Abilities:

Language	Read	Write	Speak

VI. ESSAY
The following are expressions of José Jaime Pierluisi. Please select one and write an essay (English or Spanish; two pages or less) on the meaning of these expressions to you.

A. "Sometimes during life you have to face unexpected problems with courage and determination. You cannot hesitate when you have to make difficult decisions. And if you think you made the right decision, you have to stand by it." José Jaime Pierluisi's Harry Truman Scholarship Application Essay 1983

B. "Si sólo recordamos y no reconocemos el crecimiento de nuestros principios y valores, y nuestro compromiso y deber para con la comunidad, nos habremos fallado a nosotros mismos . . ." José Jaime Pierluisi's Salutatorian Speech, Graduating Class 1983, Colegio San Ignacio.

V. AUTHORIZATION AND NOTES

A. This application must include:

* Copy of letter of admission to graduate school.
* Certificate of Good Conduct - Puerto Rico Police Department
* Undergraduate Official Copy of University transcript record.
* Required Essays

B. The completed application and the above stated documents must be received by the José Jaime Pierluisi Foundation no later than Friday, June 13, 2008 (5:00 p.m.) at the following address:

José Jaime Pierluisi Foundation
PMB 301
1353 Rd. 19
Guaynabo, PR 00966

C. No documents will be returned.

D. I authorized the José Jaime Pierluisi Foundation to verify any or all of the information provided by me. False information will invalidate this application.

_____________________	_______________________
DATE	SIGNATURE