Application Form:
2017 Patrick Malone & Associates “Representing Real People” Scholarship Application Form
STUDENT INFORMATION
Name (Last, First, MI):____________________________________________________________
Are you a U.S. citizen or otherwise authorized to work in the United States? ___Yes ___No
Name and city of school you are attending or planning to attend:
______________________________________________________________________________
(NOTE: You must submit an acceptance letter from an accredited law school in the United
States, or if you’re currently enrolled, please submit proof of attendance and transcripts of
any completed terms from your law school.)
Present mailing address (Street, Apt. # City, State, Zip code):_____________________________
______________________________________________________________________________
Telephone #: __________________________________
E-Mail: _______________________________________
ACADEMIC INFORMATION
 Schools 			Address
Dates
Degree / Major
Date of
Graduation
Highlight honors or awards that you have received:

Is there any other relevant information you want us to consider when reviewing your
application?
Tell us about why you want to represent real people in your law career.
ESSAY INSTRUCTIONS:
Please submit an essay of one to three pages describing why you believe you are the
most deserving recipient for this scholarship.
Please attach your essay as a separate document.
CERTIFICATION:
The undersigned scholarship applicant hereby grants permission to use his/her name and to
quote his/her essay (in whole or in part) or use his/her Entry (in whole or in part) in all
promotional and other activities relating to the scholarship, including, but not limited to,
publication in written materials, posting on websites and other social media, and use in
radio and television broadcasts. In the event that a Scholarship applicant participates in any
promotional or other activity relating to the Scholarship, the applicant authorizes Patrick
Malone & Associates to use, reuse, publish, re-publish, and copyright audio and/or visual
reproductions of the applicant's voice and/or image, alone or with other persons, with or
without use of the applicant's name.
I hereby certify that the information I have provided on this Application Form and in
any attached materials is true and complete.
Applicant Signature: _____________________________________________________________
Date: __________________

Attach to this completed form your:
a.
b.
c.
d.
Personal essay.
Proof of acceptance to or current attendance at a U.S. accredited law school.
Official transcript for all completed terms in law school up to date of application.
Official complete transcript for all undergraduate college attendance.
Return completed application and supporting materials either by mail or by e-mail in
PDF format by July 1 to:
Kim McBurrows
1310 L St NW #800, Washington, DC 20005
    KMCBurrows@pmalone.com
For more information, visit our scholarship page.
Note: This application and supporting material must be received by July 1 of the year for which
the application is made. Notification of the scholarship award decision will be made on or
around August 1.