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JUSTINIAN LAW SOCIETY OF MASSACHUSETTS, INC.

APPLICATION FOR SCHOLARSHIP AWARD

1. Name_____________________________________________________________ Telephone Number: _____-_____-______
                                             (Last) (First) (Middle)

2. Address ____________________________________________________________________________________________
                                              (Street and No.) (City or Town) (State) (Zip Code)

3. Birth Place ___________________________________________________________________ Birth Date

4. Are you a student member of the Justinian Law Society? Circle one: YES NO

5. Is anyone in your family a member of the Justinian Law Society? Circle one: YES NO

5a. If so, who? ___________________________________________________________________________________________

6. Mother’s Name __________________________________________ Occupation _____________________________________

7. Father’s Name ___________________________________________ Occupation _____________________________________

8. Law School ___________________________________________ Anticipated date of Graduation (Month/Year): _____________

9. Grade Point Average ________ out of _________ 9a. Class Rank ___________ out of ________

11. Annual Law School Tuition ________________

12. Legal Field of Interest ________________________________________________________________________________

Date of Application: ____________________ Signature: ________________________________________________________

IMPORTANT

MAIL APPLICATION, RESUME, TRANSCRIPT, LETTER OF REFERENCE,
AND YOUR PERSONAL STATEMENT, IN ONE ENVELOPE, POSTMARKED NO LATER THAN NOVEMBER 10, 2006,
                                
TO:

JOHN F. TOCCI, ESQ.
TOCCI, GOSS & LEE, PC
35 INDIA STREET, 5^TH FLOOR
BOSTON, MA 02110