2009-10 Texas AFL-CIO Scholarship Application
2010 TEXAS AFL-CIO
SCHOLARSHIP APPLICATION
(FOR HIGH SCHOOL SENIORS ONLY)
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This form must be completely filled out and (ATTACH PHOTO HERE)
signed by applicant and Union Officer, a parent or
legal guardian. You must attach a copy of your high
school transcript and a photograph (head shot) for
processing. Incomplete applications
will be returned!
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PERSONAL DATA
APPLICANT’S NAME: ______________________________________________________SEX: ____ M ____ F
HOME ADDRESS: __________________________________ _______________ CITY: ________ ZIP:_______
E-MAIL, IF AVAILABLE: _____________________________ SS#: ___________________________________
PHONE: ____________________________________________________________________________________
MOTHER OR LEGAL GUARDIAN’S NAME: ___________________ OCCUPATION: ___________________
HOME ADDRESS________________________________ CITY: _________________________ ZIP:_________
FATHER OR LEGAL GUARDIAN’S NAME: _____________________________________________________
OCCUPATION: ______________________________________________________________________________
HOME ADDRESS: _____________________________________CITY: ___________________ ZIP: _________
ACADEMIC DATA
HIGH SCHOOL: ___________________________________ PRINCIPAL: ______________________________
MAILING ADDRESS: ____________________________________________ CITY: _________ ZIP: ________
GRADE POINT AVERAGE: ___________________________________________________________________
IN WHAT EXTRA CURRICULAR ACTIVITIES DO YOU PARTICIPATE? ___________________________________________________________________________________________
ARE YOU REGISTERED TO VOTE? ____________________________________COUNTY: ______________
VOTER REGISTRATION NUMBER: ____________________________________________________________
WHAT COLLEGE DO YOU HOPE TO ATTEND?__________________________________________________
DESCRIBE ANY SPECIAL CIRCUMSTANCES (HARDSHIPS) CREATED BY HEALTH PROBLEM, STRIKE, LAY-OFFS, ETC.
____________________________________________________________________________________________
____________________________________________________________________________________________
LIST ANY SCHOLARSHIPS YOU HAVE APPLIED FOR AND/OR RECEIVED:_________________________________________________________________________________
___________________________________________________________________________________________
____________________________________________ ______________________________________
PARENT’S OR LEGAL GUARDIAN’S SIGNATURE APPLICANT’S SIGNATURE
AFFILIATION
ARE YOU A UNION MEMBER? _________ YES __________ NO
IF YES, GIVE FULL NAME OF LOCAL UNION AND NUMBER: ____________________________________
____________________________________________________________________________________________
IS MOTHER OR LEGAL GUARDIAN A UNION MEMBER? _______ YES ______ NO
IF YES, GIVE FULL NAME OF LOCAL UNION AND NUMBER: ___________________________________
___________________________________________________________________________________________
IS FATHER OR LEGAL GUARDIAN A UNION MEMBER? _____ YES _____ NO
IF YES, GIVE FULL NAME OF LOCAL UNION AND NUMBER: ____________________________________
____________________________________________________________________________________________
GIVE FULL NAME OF CENTRAL LABOR COUNCIL HIS/HER UNION IS AFFILIATED:
(NAME) ________________________________________(OFFICER) __________________________________
(THE PART BELOW MUST BE COMPLETED BY LOCAL UNION PRESIDENT OR SECRETARY-TREASURER – NO EXCEPTIONS!!!):
I certify that ____________________________________________ is a member in good standing with
Local number ____________________________________ of ___________________________________ union
located __________________________________________________.______________Our central labor council
Address City Zip
affiliation is with_________________________________________________________________________CLC.
___________________________________ ___________________________________
Name of Union Officer Position Held
__________________________________ ___________________________________
Signature of Union Officer Date
THIS APPLICATION MUST BE POSTMARKED NO LATER THAN MONDAY, FEBRUARY 1, 2010.
MAIL APPLICATION TO:
TEXAS AFL-CIO EDUCATION DEPARTMENT
P. O. BOX 12727, AUSTIN, TEXAS 78711
opeiu #298 afl/cio
