San Silverio Shrine of Dover Plains Scholarship Application
This scholarship is intended for full time undergraduate college students (12 credits or more), with a cumulative GPA of at least 3.0, OR post graduate students with a GPA of 3.5 or above, OR high school Seniors planning to attend college and have an 85% and above average. The Scholarship Committee will select the winner(s) of the award from the applicant pool. Multiple winners may be selected depending on funding and at the discretion of the Scholarship Committee Members. Please do not contact board members to ask about the status of your application. The winner(s) of the scholarship(s) will be notified via mail, and their names will be announced during the annual dinner dance. The winner(s) name(s) will also be published on website. The Scholarship Committee will only consider and award the scholarship(s) to applicants that provide supporting documents by the designated deadline.

Deadline to apply for the San Silverio Shrine of Dover Plains Scholarship is July 1st.

After you submit your application, please send your official transcript to: San Silverio Shrine of Dover Plains, Attn: Scholarship Committee, 124 Oakley Avenue, White Plains, NY 10601. The official transcript must come directly from your high school or College/University by July 1st. Allow 45 days from the deadline date (stated above) to receive a response. Applicants may apply each academic year (defined as Fall and Spring combined) they are enrolled and comply with the requirements.

If awarded, the scholarship check will be sent directly to the college or university.
Email address *
Application Date *
Applicant's Name: *
Phone Number: *
Mailing Address: *
Please include your full mailing address (Street, City, State and Zip Code)
Are you a member of the San Silverio Shrine? (family memberships consist of any children under 18 years of age. Those over 18 years of age are only considered members if they have their own "single" membership) *
Do you do any volunteer work at the Shrine or any where else? If other, indicate organization. *
Is this the first time you're applying for this scholarship? *
If you replied NO to the above, please indicate the year you last applied for this scholarship, and if the scholarship was awarded:
Indicate the college or university you are planning or currently attending: *
For what term is this scholarship request? *
What degree and major are you enrolled or plan on being enrolled in? *
What is your current cumulative GPA *
Please provide your official transcript from the college or high school you are currently attending as proof of your current standings.
Contact Person
(if different from the applicant)
Relationship to applicant:
Contact Person's E-mail Address:
Contact Person's Phone Number
In approximately 750 words, tell us a little bit about yourself and include one or more of the following criteria: Character traits, future goals, volunteer work, charity work, family and culture. The San Silverio Shrine Scholarship Committee will use your essay and academic achievements to make their final decision. *
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This form was created inside of San Silverio Shrine of Dover Plains, Inc..