2023 Student Scholarship Application

Please fill out the information requested below. After you click submit, you will thanked for taking the 'survey.' This is your confirmation that your application has been sent.

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* 1. Member's Name: Last, First, Initial

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* 2. Member Work Site & Shift:

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* 3. Member's Phone #:

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* 4. Parent/Guardian's Name: Last, FIrst, Initial

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* 5. Parent/Guardian's Address:

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* 6. Student's Name: Last, First, Initial

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* 7. Student's Date of Birth:

Date

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* 8. Student's Social Security #:

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* 9. Student's Address:

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* 10. Note: This Scholarship Applies only to NEXT Year's Tuition:
Is applicant a dependant of member as defined by the IRS?

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* 11. I am applying for the (semester):

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* 12. I will be a:

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* 13. I plan on attending ______ college/university.

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* 14. College/University Address:

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* 15. College/University Phone #:

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* 16. Name of graduating High School:

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