LOCAL 753

SCHOLARSHIP APPLICATION

Application Deadline: Postmarked by July 1, 2007

Information must be filled out by applicant. Please type or print clearly.

Personal Information Name Home Address City, State Zip Code Phone SSN	Union Affiliation Who in your family is a union member? Check all that apply. □ Self Member Since ____________________ □ Spouse Name _________________________ Member Since ____________________ □ Father Name _________________________ Member Since ____________________ □ Mother Name _________________________ Member Since ____________________ Union Members Email Address: _________________________________________
By June 2007, I will have completed: □ High School □ 1^st year college □ 2^nd year college □ 3^rd year college □ 4^th year college □ Other: ________________________________	Grade Point Average: (You must have a grade point average of 2.50) My current GPA is: _____________________
I will be attending SCSU (check all that apply):	If you are selected to receive this scholarship
□ Fall Semester 2007 □ Spring Semester 2008 □ Summer 2008 (Note: You must be registered for at least 3 credits/semester to be eligible for a scholarship)	your fee statement will reflect the credit of the designated semester (select only one): □ Fall Semester 2007 □ Spring Semester 2008 □ Summer Session I/II 2008

I certify that the information on this application is correct and true.

_______________________________________ _____________________

Signature of Applicant Date