APPLICANT’S NAME_________________________________________________________ADDRESS_______________________________________________________________
CITY__________________________STATE_______ZIP______________________
HIGH SCHOOL____________________________________________________________
CITY_____________________________ STATE_______ ZIP________________
DATE OF GRADUATION___________________
SOCIAL SECURITY NO._________________________
DATE OF BIRTH_____________________ MALE_________ FEMALE________
COLLEGE OR UNIVERSITY OF YOUR CHOICE:
1)_______________________________________________________
2)_______________________________________________________
3)_______________________________________________________
PARENT/GRANDPARENT MEMBER’S NAME___________________________________________
PARENT/GRANDPARENT MEMBER'S SOCIAL SECURITY NO.______________________
TEL. NO.__________________________________
MEMBER’S ADDRESS____________________________________________________
CITY_______________________ STATE_____ZIP_______________
EMPLOYER’S NAME__________________________________________________________
CITY_________________________ STATE_____ZIP___________________
UNION SEAL
SPACE BELOW TO BE FILLED IN BY THE PRESIDENT OF THE LOCAL UNION
I hereby certify that the Applicant named above is eligible to apply for the Teamsters Local #42 Scholarship Grants. I further certify that said Applicant is a child, stepchild or legally adopted child or grandchild of the Member named above, and that said Parent/Grandparent is in good standing of Local #42
SIGNATURE__________________________________________________
DATE____________________
MANDATORY DOCUMENT THAT MUST BE ATTACHED TO THIS APPLICATION:
LETTER OF ACCEPTANCE TO ONE OR MORE OF THE ABOVE SCHOOLS
NOTE: Must be signed by the Applicant
SIGNATURE______________________________________________
DATE ______________________
SIGNATURE OF PARENT/GRANDPARENT MEMBER OF LOCAL NO. 42
_______________________________________________________
SOCIAL SECURITY NUMBER OF MEMBER____________________________