APPLICANT INFORMATION

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1 APPLICANT INFORMATION LAST NAME FIRST NAME M.I. ADDRESS CITY STATE ZIP CODE TELEPHONE ADDRESS DATE OF BIRTH HIGH SCHOOL EXPECTED DATE OF GRADUATION FULL NAME OF TEAMSTER PARENT TEAMSTER PARENT S BADGE NUMBER FULL NAME OF ACCREDITED COLLEGES OR TECHNICAL SCHOOL TO WHICH YOU PLAN TO ATTEND SCHOOL NAME MAJOR COURSE OF STUDY DEGREE OR CERTIFICATE SOUGHT Please attach to this application a copy of the letter of acceptance from the accredited college or technical school to which you plan to attend. LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 1

2 GOALS AND ASPIRATIONS Make a brief summary of your plans as they relate to your educational objectives Please provide any additional information that you believe would be helpful to the Core Scholarship Committee in assessing your personal or financial need EXTRA-CURRICULAR Please attach an outline of your activities, work experiences, honors, distinctions, achievements and one letter of appraisal from a present teacher, guidance counselor or employer. Incomplete applications will not be considered. CERTIFICATION In submitting this information, I certify that the information is accurate and complete to the best of my knowledge. Falsification of information may result in termination of any scholarship granted. This application becomes the property of Teamsters Local 1150 and I acknowledge all decisions of the Teamsters Local 1150 Core Scholarship Committee are final. APPLICANT S SIGNATURE DATE TEAMSTER PARENT S SIGNATURE DATE LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 2

3 TRANSCRIPT INFORMATION An official transcript of grades must be sent with this application. On-line transcripts and grade reports are not acceptable. The appropriate school official must complete the following section: APPLICANT S NAME APPLICANT S CLASS RANK TOTAL CLASS SIZE SAT1 TOTAL SCORE (IF APPLICABLE) ACT TOTAL SCORE (IF APPLICABLE) SCHOOL OFFICIAL S SIGNATURE PRINT NAME DATE TITLE TELEPHONE SCHOOL ADDRESS CITY STATE ZIP CODE LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 3

4 This Section is to be completed by Teamsters Local 1150 SECRETARY-TREASURER S MEMBERSHIP VERIFICATION TEAMSTER PARENT S NAME BADGE NUMBER I hereby certify that the above-named Teamster member has not been an officer or employee of Teamsters Local 1150 and has been a member in good standing (check the appropriate box below): for a minimum of 12 consecutive months prior to the application deadline for a minimum of 12 consecutive months prior to her/her (circle one) retirement/ disability/death for a minimum of 12 consecutive months prior to his/her layoff date of for less than 12 consecutive months prior to the application dead line of but has had 12 consecutive months of membership in good standing at some other time I verify, on the basis of the Teamster parent s membership record, that his/her son or daughter would be eligible to apply for this program: YES NO SECRETARY-TREASURER S SIGNATURE After March 31, 2018 the Scholarship Fund will not process applications. Upon completion, please forward this application to: TEAMSTERS LOCAL 1150 SCHOLARSHIP FUND 150 GARFIELD AVENUE STRATFORD, CT CHECKLIST Please use this checklist as a tool to ensure you submit a complete application. Remember, incomplete applications will not be considered. APPLICATION TRANSCRIPT ACTIVITIES LIST LETTER OF RECOMMENDATION LETTER OF ACCEPTANCE FROM SCHOOL YOU ARE ATTENDING LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 4

5 THE PROGRAM Teamsters Local 1150 has established a scholarship fund to assist eligible applicants in their pursuit of higher learning and career building. This includes full time study in an accredited college or university or a technical school. We consider all applicants without regard to race, religion, gender, disability, or any other legally protected status. Eleven $1,000 one-time scholarships will be awarded. These scholarships are disbursed to the college, university or technical school of the recipient s choice at the beginning of the recipient s freshman year. A recipient may not apply if she or he is attending a tuition-free institution or attending an institution tuition-free. Eligibility requirements and application procedures are the same for all 11 awards. The Teamsters Local 1150 Core Scholarship Committee will confirm applications are complete and applicants are eligible. An impartial, independent educator will review all potential recipient applications and select the 11 recipients. SELECTION OF RECIPIENTS Scholarship recipients are selected on the basis of academic record, demonstrated leadership, participation in school and community activities, honors, work experience, goals and aspirations stated in the application, unusual personal or family circumstances and one outside appraisal from an applicant s teacher, guidance counselor or employer. ELIGIBILITY Students Applicants to the program must graduate from high school during the academic year. The applicant must be a daughter or son of a Teamster Local 1150 member. Financial dependents (i.e., stepchildren and wards) of Teamster Local 1150 members are eligible if the member contributes in excess of 50% of the applicant s financial support and if the applicant is a financial dependent of the member for federal income tax purposes. Proof of this relationship may be required. Teamsters Local 1150 Parent The applicant s Teamster parent must have been a member in good standing during the 12 consecutive months preceding the application deadline of March 31, In addition, the Teamster parent must not have been a Teamster officer or an employee of local 1150 during this period, nor may the parent presently serve on the Core Scholarship Committee. LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 5

6 If the applicant s Teamster parent is retired or deceased, she or he must have been a member in good standing for the 12 consecutive months preceding his or her retirement or death. Furthermore, the member must not have been an officer or employee of local 1150 during the 12- month period stated above. If the Teamster member has deposited a withdrawal card during the 12 months preceding the application deadline, she or he must have been a dues-paying member for 12 consecutive months prior to taking the withdrawal card. During both periods, the member must not have been a Teamster officer or employee of local 1150 and must have been a member in good standing. In cases of automatic withdrawal, the same rule applies. APPLICATION Applications can be obtained from the Local 1150 Union Hall or by accessing the local s website at: Interested students must complete the application in full and mail it along with a current complete official transcript of grades (on-line transcripts and grade reports are not acceptable), a letter of recommendation from a teacher or employer and an activities list to The Teamsters Local 1150 Scholarship Fund and be postmarked no later than March 31, If applications are hand delivered to the Local 1150 Union Hall they must be delivered in a sealed envelope. Applicants are responsible for gathering and submitting all necessary information. Applications are evaluated on the information supplied; therefore, answer all questions as completely as possible. All information received is considered confidential and is reviewed only by the Core Scholarship Committee and the advisor. Incomplete applications will not be considered. REVISIONS Teamsters Local 1150 reserves the right to review the conditions and procedures of this scholarship program and to make changes at any time including termination of the program. ADDITIONAL INFORMATION Please contact Teamsters Local 1150 should you have any questions regarding the scholarship program: CONNECTICUT (203) (800) ALABAMA 1(800) FLORIDA 1(800) LOCAL 1150 SCHOLARSHIP FUND APPLICATION Page 6

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