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CIVIL SERVICES EMPLOYEES ASSOCIATION

FINGER LAKES DDSO LOCAL 436


620 Westfall Road
Rochester, NY 14620
LOCAL 436 SCHOLARSHIP APPLICATION
Application Due Date: April 15th, 2016
Return completed application to: Scholarship Committee at address listed above.
THE AWARD:
CSEA Local 436 scholarships are an award of $500 to be paid directly to the
Financial Officer of the college each recipient will be attending.
ELIGIBILITY:
Potential recipient must be planning to attend an accredited college, university,
or trade school located in New York State or Pennsylvania for a minimum of 6
credits per semester, in pursuit of a college degree.
AND
A graduating high school senior who is a dependent child of an active CSEA
represented member or agency shop fee payer with at least one year of employment
under CSEA;
OR
An active CSEA represented member or agency shop fee payer with at least one year
of employment under CSEA.
Scholarship funds must be used: (1) for tuition, (2) only at an accredited
educational institution; and (3) by January 31, 2017.
If you or your dependent child was a recipient of an award for the previous
initiative, specifically for the Fall Semester 2015/Spring Semester 2016, neither
you nor your dependent child can be considered for this year's offering.
APPLICATION PROCESS:
You must submit, as a package, the following information:
____ a typed personal essay (500 word minimum; 1000 word maximum) telling us
about yourself and explaining your reason(s) for wanting to be a recipient of one
of Local 436's scholarships (up to three $500 scholarships will be awarded for
the Fall 2016/Spring 2017 semesters). Include future goals/plans and any
extenuating circumstances you wish to be considered.
____ the completed Scholarship Application
____ one (1) letter of recommendation from a teacher/guidance counselor or
supervisor.
and at least one of the following:
____ one (1) personal letter of recommendation (not a relative nor
high school employee/teacher).
____ one (1) letter of recommendation from an organization for which you did
community service.

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SELECTION PROCESS:
Recipients will be selected based on their overall school experience and
achievements, community service and essay submitted. In addition, a minimum of
two different letters of recommendation are required. Judging will be based on
both subjective criteria, such as essays and references, and weighted, objective
criteria such as academic honors/awards, extracurricular activities and community
service activities.
APPLICATION DEADLINE:
Application must be returned to CSEA Local 436, Scholarship Committee, 620
Westfall Road, Rochester, NY 14620, no later than April 15, 2016.
RECIPIENTS WILL BE ANNOUNCED BY MAY 20, 2016.
Note: Please be sure you include all information required with your application.
Incomplete applications will NOT be considered. Applications will not be accepted
if postmarked after April 15, 2016.
REMEMBER: YOUR PERSONAL ESSAY MUST BE TYPED.

CSEA Local 436


SCHOLARSHIP APPLICATION
Fall Semester 2016/Spring Semester 2017
Application Due Date: April 15th, 2016
Return completed application to: Scholarship Committee
CSEA Local 436
Finger Lakes DDSO
620 Westfall Road
Rochester, NY 14620
Name of Applicant: _____________________________________________
Last First MI
Street Address: ________________________________________________
City or Town: _____________________________ County: ____________
State: ____ Zip Code: ________________ SS#: __________________
Date of Birth: ________________ Phone #: __________________
(FOR PROOF OF CSEA MEMBERSHIP--SOCIAL SECURITY NUMBER OF QUALIFYING CSEA MEMBER
MUST BE SUBMITTED WITH APPLICATION)
For graduating high school seniors, complete the following information:
Name and SS# of CSEA member and relationship - for verification purposes:

Name and address of high school currently attending:


______________________________________________________________
High School Graduation Date: _________________________________
Name and phone number of Guidance Counselor or Principal:
College, University or Trade School you have been accepted to attend or have
applied for acceptance: ________________________

Major field of study: _________________________________________


Degree sought: ___________________ Anticipated date: _________

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Achievements Dates
Past and current ACADEMIC HONORS OR AWARDS

Past or current EXTRACURRICULAR ACTIVITIES (include all sports, clubs,


etc, along with offices held)

Past and current COMMUNITY SERVICES (include ALL volunteer work)

Certification and Release Authorization


I certify this information is true, complete, and accurate. I also authorize
release of information to confirm and/or verify this application. If I am awarded
a scholarship, CSEA Local 436 may use my name and/or photo for publicity
purposes.
_______________________________ _______________________________
Student's Signature Parent/Guardian's Signature