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ADLER POLLOCK & SHEEHAN DIVERSITY SCHOLARSHIP - page 3 / 6

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ADLER POLLOCK & SHEEHAN DIVERSITY SCHOLARSHIP

APPLICATION FORM

Eligibility:  1)   Acceptance at and notice of intention to attend an ABA accredited law school

                            in the United States.

        2)  Permanent residence in Massachusetts or Rhode Island and legal residence  in

                 the United States.

                3)  Member of a diverse group (for example, African American, American Indian,  

                        Hispanic, Asia/Pacific Islander, Gay/Lesbian, or other minority group).

(PLEASE TYPE APPLICATION FORM)

STUDENT INFORMATION

Name:LastFirst      MI

Present Mailing Address:  ________________________________________________________

 StreetApt. #

______________________________________________________________________________

CityStateZip Code

Permanent Mailing Address:  

Street               Apt. #

______________________________________________________________________________

City                State                                         Zip Code

After what date should the permanent address be used:  

Telephone #:____________________    ____________________      ____________________  

Home    Cell           Other

E-mail:  Fax #:

Identify diverse group of which you are a member:

Date residency in MA or RI began:  .  Addresses where you have resided in Massachusetts or Rhode Island (Proof of legal residency in U.S. to be submitted with application):

Address

Dates

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