UFCW 1500 Scholarship Form This form is for you to Request a UFCW Local 1500 Scholarship Application. MEMBER INFORMATION First Name Last Name UFCW Member ID # Email Address Phone Number Address 1 Address 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Are you currently a UFCW Local 1500 Member? Yes No IF YES, WHAT COMPANY AND STORE DO YOU WORK FOR? Company Name Store # Are you Full or Part-Time? Full-Time Part-Time IF YOU ARE APPLYING FOR YOURSELF, PLEASE ANSWER THE FOLLOWING QUESTIONS: Are you a High School Senior College Student If you are a college student, do you have a minimum of two semesters left to complete Yes No IF YOU ARE A MEMBER AND YOU ARE A HIGH SCHOOL SENIOR OR A COLLEGE STUDENT WITH AT LEAST TWO SEMESTERS LEFT TO COMPLETE YOUR DEGREE, YOU MAY APPLY FOR A SCHOLARSHIP ON YOUR OWN BEHALF In two or three sentences, please share how Local 1500 has helped you and your family IF APPLYING FOR A DEPENDENT, PLEASE ANSWER THE FOLLOWING QUESTIONS Is your dependent a high school senior? Yes No THE ONLY DEPENDENTS WHO ARE ELIGIBLE FOR SCHOLARSHIP ARE HIGH SCHOOL SENIORS. DEPENDENTS WHO WILL BE COLLEGE STUDENTS IN THE FALL ARE NOT ELIGIBLE Information About High School Senior First Name Last Name Email Address Phone Number Address 1 Address 2 City State Describe your dependent's relationship to you Expected High School Graduation Date: What is 2+2?* Prove you are a human
