Application for Scholarship

Please print clearly and complete all areas.

· I _______________________________________________________________hereby make application for scholarship.

· Home Address: ______________________ City/Town: __________________________ St: _____ Zip Code:________

· Home Phone: _______________ Home Fax: _______________ Home: E-mail: :___________________________________

· Emergency Contact: ____________________________ Home Web Address: ____________________________________

· Grade Averages (Use reverse side for additional information.)

Ø Freshman English _____ Math _____ Social Studies _____ Science _____ Language _____ Extra Curricular, Clubs,

Offices Etc: __________________________________________________________________________________________

Ø Sophomore English _____ Math _____ Social Studies _____ Science _____ Language _____ Extra Curricular, Clubs,

Offices Etc: __________________________________________________________________________________________

Ø Junior English _____ Math _____ Social Studies _____ Science _____ Language _____ Extra Curricular, Clubs,

Offices Etc: __________________________________________________________________________________________

Ø Senior English _____ Math _____ Social Studies _____ Science _____ Language _____ Extra Curricular, Clubs,

Offices Etc: __________________________________________________________________________________________

· Plumbing Apprentice License Number: __________________ Gas Apprentice License Number: __________________

· School Applied To:_______________________________ Are You Interested In Joining Our Association: (Y) ___ (N) ___

· What makes you deserving of this scholarship?

· Tell Us What Interests You About Our Industry?

· Why Do You Feel You Would Continue Working In Our Industry After Graduation?

· Signature of Applicant:_________________________________________________Date:_____________________

 

· Signature of Sponsor:______________________________ (Print Name) _____________________Date:_________________

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