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SOUTHEAST BRANCH - D. RAY JONES SCHOLARSHIP APPLICATION |
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Application
Applicant
is: Active Member
(circle
one) Former Active Member
Spouse, Child, or Grandchild of an Active Member of the
Southeast
Branch, Texas Chapter of A.P.W.A.
Name
of Applicant____________________________________Years lived in
Texas__________
Address______________________________________________Phone
Number_____________
Total
Number of People Living in Household__________
Annual
Gross Household Income___________________
EMPLOYMENT
INFORMATION
Present
Employer_____________________________Years of
Employment_________________
Present
Position________________________________________________________________
Please
List 3 Character References:
Name_________________________Address&
Phone #_________________________________
Name_________________________Address&
Phone #_________________________________
Name_________________________Address&
Phone #_________________________________
COMPLETE
ONLY IF YOU ARE A SPOUSE, CHILD, OR GRANDCHILD OF A MEMBER
Parent/Grandparent/Spouse
Name__________________________________________________
Parent/Grandparent/Spouse
T.P.W.A. Affiliation: Group
Active
Associate
Parent/Grandparent/Spouse
Employer_______________________________________________
Position_______________________________________________________________________
EDUCATIONAL
DATA
ATTACH
TRANSCRIPT OF MOST RECENT SCHOOL ATTENDED
List
scholastic honors, club/organization memberships, religious
affiliations, extra curricular activities:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
NOTE: PLEASE ATTACH TO THIS APPLICATION
(2) COPY OF TRANSCRIPT FROM THE MOST RECENT SCHOOL ATTENDED
I
hereby certify the foregoing information is true and correct and
agree if selected as a recipient of the D. Jones Scholarship Fund,
the cash received will be used in assistance of attending a college,
university or any special courses as defined by the Scholarship
Committee or stated in the eligibility requirements.
If the cash awarded me is not used for the purpose, it will
be returned to the D. Ray Jones Scholarship Fund.
Signature
of Applicant_____________________________Date_________________________
MAIL
COMPLETED APPLICATION
.......................................................................................................................................
AMERICAN
PUBLIC WORKS ASSOCIATION
D.
RAY JONES SCHOLARSHIP FUND
P.O.
BOX 2825
HOUSTON,
TX 77252-2825
ATTN:
SCHOLARSHIP COMMITTEE
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