Application

The American Institute of Polish Culture’s annual Harriet Irsay Scholarship committee is ready to receive submissions. Every year 10-15 worthy USA-based students receive $1,500 each. Applicants should preferably be of Polish heritage or involved and interested in Polish related issues.

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HARRIET IRSAY SCHOLARSHIP 2021-2022

offered by

THE AMERICAN INSTITUTE OF POLISH CULTURE

1440 79^th Street Causeway, Suite 117

Miami, FL 33141

Closing date for submission of ALL required materials – July 24, 2021

Announcement of awards by mid-September, 2021

1. NAME

Mr.

Mrs.

Ms.

2. CONTACT INFORMATION

Mailing Address

Permanent Addres

If different from mailing address

Telephone

3. Would you like us to add your email to our mailing list?

Yes

4. PLACE OF BIRTH

5. DATE OF BIRTH

6. FAMILY BACKGROUND

Father's name

Occupation

Telephone

Date of birth

Place of birth

Ethnic background

Present address

Mother's name

Occupation

Telephone

Date of birth

Place of birth

Ethnic background

Present address

7. PRESENT CITIZENSHIP

You must be a US citizen or a green card holder. Please include a copy of your green card if applicable.

8. NAME OF THE SCHOOL IN WHICH YOU ARE CURRENTLY ENROLLED

I am a

Freshman

Sophomore

Junior

Senior

What is your present major?

What is your intended major?

What fellowships or financial grants do you presently hold, if any?

9. HOW MUCH FINANCIAL AID DO YOU EXPECT TO RECEIVE FOR THE ACADEMIC YEAR?

List all grants, scholarships, loans and other support for which you have applied

10. HOW MUCH FINANCIAL AID WILL YOU RECEIVE MONTHLY FROM YOUR PARENTS?

11. LIST HONORS AND DISTINCTIONS YOU HAVE ACHIEVED AS A STUDENT

12. HAVE YOU PUBLISHED ANY ARTICLES, THESES OR BOOKS? IF SO, PLEASE INDICATE THEIR TITLES, PLACE AND DATE OF PUBLICATION.

13. HOW WOULD YOU RATE YOUR KNOWLEDGE OF THE POLISH LANGUAGE?

none

poor

fair

good

excellent

14. WHAT ARE YOUR INTERESTS AND ACTIVITIES OUTSIDE OF SCHOOLWORK OR PROFESSIONAL ACTIVITIES?

15. LIST THREE (3) PROFESSORS OR TEACHERS WITH WHOM YOU HAVE STUDIED OR THREE (3) AUTHORITIES IN YOUR FIELD WHO CAN ATTEST TO YOUR ACADEMIC OR PROFESSIONAL ABILITY WHOM YOU WILL REQUEST LETTERS OF RECOMMENDATION.

The letters must be sent (preferable) or emailed (from recommender's professional email address) directly to the Institute and they must be ORIGINAL, SIGNED and ON LETTERHEAD paper.

Name

Title or Position

Address

Telephone

Name

Title or Position

Address

Telephone

Name

Title or Position

Address

Telephone

IMPORTANT

You must ask your school to mail (preferable) or email (from school email address) your official transcript to the Institute. If not presently enrolled in any school, send the transcript from the last school which you attended.

Note that all information you have provided in this application will remain confidential property of AIPC, and will not be sold nor divulged to any 3rd party under any circumstances.

All documents should be sent to: AIPC Harriet Irsay Scholarship, 1440 79th Street Causeway, Suite 117, Miami, FL 33141

I agree that my typed name below will be valid as a handwritten signature to the extent allowed by local law

HARRIET IRSAY SCHOLARSHIP 2021-2022

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