2013 TEXAS AFL-CIO

SCHOLARSHIP APPLICATION
(FOR HIGH SCHOOL SENIORS ONLY)
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This form must be completely filled out and
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

. Incomplete applications
will be returned!
processing

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PERSONAL DATA
APPLICANTS NAME: ______________________________________________________SEX: ____ M ____ F
HOME ADDRESS: __________________________________ _______________ CITY: ________ ZIP:_______
E-MAIL, IF AVAILABLE: _____________________________ SS#: ___________________________________
PHONE: _____________________________________________________________________________________
MOTHER OR LEGAL GUARDIANS NAME: ___________________ OCCUPATION:
____________________
HOME ADDRESS________________________________ CITY: _________________________ ZIP:_________
FATHER OR LEGAL GUARDIANS 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 __________________________
_____________________________________________________________________________________________
______________________________________________
PARENTS OR LEGAL GUARDIANS SIGNATURE

__________________________________________
APPLICANTS 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 SECRETARYTREASURER 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 THURSDAY JANUARY 31, 2013.
MAIL APPLICATION TO: TEXAS AFL-CIO EDUCATION DEPARTMENT
P. O. BOX 12727, AUSTIN, TEXAS 78711

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