Richard C. Felch Memorial
Scholarship Application - 2017

 
 
 
 

APPLICANTíS 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 MEMBERíS NAME___________________________________________

PARENT/GRANDPARENT MEMBER'S SOCIAL SECURITY NO.______________________

TEL. NO.__________________________________

MEMBERíS ADDRESS____________________________________________________

CITY_______________________ STATE_____ZIP_______________

EMPLOYERíS 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____________________________

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