Please print out this form and mail completed application no later than 11/1/2012 along with four (4) letters of reference (non-family) to:

Berkshire Scholarship Fund
Selection Committee
P.O. Box 170
Womelsdorf, PA 19567-0170

Name
Address
City/State/Zip
Home Phone
High School
Address
City/State/Zip
H.S. Coach
Phone
Summer Coach
Phone
Guidence Counseler
Phone
Graduation Year
SAT/PSAT
GPA
Class Rank
Eligibility Requirement (check all that appy):	___ Current or Former Berkshire Bobcats 18-U Player
	___ Current or Former Berkshire Red Sox 18-U Showcase Player
	___ Current Berkshire Red Sox Collegiate Player
	___ Current Berkshire Red Sox Optimist Player
	___ Past B-T-B/B-T-S Event Participant:
	Team Name & Year  ___________________________