MEMBER SECTION

Member's Name

 *

Member's Address

 *

Town

 *

State

 AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY  *

Zip

  *

Home Phone

  *

Member's Employer

  *

Work Phone

  *

Member's Last 4 Digits of  Social Security Number

  *

Your UPSEU Regional Office (Select one)

Long IslandUpstateMeriden, CTClinton, CTNew Jersey  *

Name of Higher Institution of Learning

Major/ Course of Study

Enrolled Credits

  *

*  Required Fields

The scholarship committee reserves the right to reject an application if false information is provided. It may from time to time, adjust the criteria, procedures, forms as is deemed necessary to protect the integrity of the scholarship program and/or to ensure its most effective use and administration. Awards are granted by lottery system.

Winners are chosen in the month of July and will be notified during the month of August . A letter will be sent indicating the award and procedure for receiving payments. Members must remain in good standing with the Union at the point of scholarship payment. The Union reserves the right to publish a list of recipients.

I understand if chosen I will need to supply the following:

Member Applicant:
Proof of enrollment (schedule or bursar receipt) and last report card received.

Dependent child:
Proof of enrollment (schedule or bursar receipt), last report card received, and birth certificate.

Step or foster child:
Proof of enrollment (schedule or bursar receipt), last report card received, birth certificate, and proof of legal guardianship by member.