APPLICATION - 2015/2016 ACADEMIC YEAR
Laborers’ International Union of North America
Local 582 College Scholarship Program
Rules for Completing Scholarship Application:
 Any member, spouse or dependent child who is attending an accredited College or
University as a full time student in the 2015/2016 school year is eligible.
 Complete ALL sections of this application.
 Type or print using black ink.
 Use N/A if question does not apply.
 Appearance and completeness WILL BE CONSIDERED during evaluation.
 All sections must be completed in order for application to be considered.
 The application must be postmarked no later than November 20, 2015.
I.
PERSONAL
Name: _______________________________________________________________________
First
Home Address:
Middle
Last
_______________________________________________________________________
Number & Street
City & State
Zip
Name of school currently attending: ________________________________________________________
Address of school: _____________________________________________________________________
Home Telephone: (
) _____________________________
Social Security Number: ______________________________________
Date of Birth: _________________ Birthplace: ____________________ Sex: Male____ Female____
Single _____
Married _____
Names and ages of children: __________________________________
Name of Local 582 Member: ______________________________________________________________
Relationship to Member: ___________________________________
LIUNA Membership No.:____________________
LIUNA Member SS No.: ______________________
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II.
ACADEMIC ACHIEVEMENT
High School Attended: _______________________________________ Year graduated: _____________
Rank in class: __________________________ Grade Point Average GPA (on 4.0 scale): ____________________
If you have taken a General Education Development Test (“GED”’), indicate the date on which that test was taken
and your score.
Date: ______________________
Score: __________________
Note: A copy of your equivalency diploma or certificate must be attached to the application.
Colleges Attended: __________________________________________ No. of years: ________________
Major: ________________________________ Grade Point Average GPA (on 4.0 scale): ____________________
If you did not graduate, have you obtained an equivalency certificate? _______________________
If so, when? ____________________________
month/year
What class work, correspondence study or tests did you take to obtain this equivalency diploma or certificate? List
the classes or courses taken and the completion date of each class or course.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
State the full name and address of the college that you have been accepted to be a full-time student.
Name of School: ____________________________________________________________________
Address: ___________________________________________________________________________
General courses not taken for College Credits
List courses not taken for college credit (such as correspondence courses, trade or night school, company or union
classes, Armed Services schools, apprenticeship classes, etc.).
Course or
subject taken
School or Organization
which gave this course
Dates course
began & ended
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Course hours
per week
Grade,
if any
III.
SCHOLARSHIP DATA
College or University you plan to attend:
___________________________________________________________________________________________
Date of Application: __________________
Accepted:
yes______ no______ unknown _______
College or University currently attending:
___________________________________________________________________________________
Other scholarships which you have applied for (list name and scholarship amount):
________________________________________________________________
$___________
________________________________________________________________
$___________
________________________________________________________________
$___________
________________________________________________________________
$___________
Scholarships or tuition assistance you have received or are now receiving (list with whom, duration and amount):
___________________________________________________________________
$ ____________
___________________________________________________________________
$ ____________
___________________________________________________________________
$ ____________
When entering college full-time this fall, how will the college classify you?
_____ Freshman _____ Sophomore _____ Junior _____ Senior
What is your estimate of the number of years of full-time study you will require to attain your B.A. or equivalent
degree?
_____ 1 year _____ 2 years _____ 3 years _____ 4 years _____ other
What is your intended major’?
_______________________________________________________________________________
Apprenticeship:
Have you been or are you now in an apprenticeship program? _________
If so, when did you start? _____________
When did you finish?______________
What company and what union sponsored this program?
________________________________________________________________________________
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IV.
EXTRA CURRICULAR ACTIVITIES AND ESSAY
In what extracurricular activities have you participated in while attending high school or college? Indicate elected
offices held, if any. Specify purposes of local organizations.
A.
Student activities by year (list student government, Key Club, National Honor Society, etc.):
B.
Community activities by year:
C.
Athletics by year:
D.
Awards or honors:
A.
An essay on organized labor union:
Attach an essay typed, double spaced (not to exceed 3 pages) on the following subject:
“Why are Unions necessary in today’s society?”
Applicant is required to sign “statement of terms and conditions” which gives permission to publish the attached
essay if selected by Local 582 in any of its communications; i.e. newsletters, magazines, etc.
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V.
STATEMENT OF TERMS AND CONDITIONS
Note: The following statement must be signed by the applicant or the application will be invalid.
I hereby indicate my understanding that the decisions of Local 582 in the selection of scholarship winners is final
and binding on all applicants. I understand that the Local reserves the right at any time and without giving any
reason to terminate, cancel or end the program provided that scholarships or awards already granted and/or
announced shall run to the end promised and publicly stated.
I agree that should I become a successful candidate for a scholarship, I shall comply with all the rules and
regulations for such scholarship. Any unapplied funds per academic year will be returned to grantor.
In the event I successfully compete for a scholarship, I hereby give my permission to the Local Union to publish the
attached essay, with my name as was required for my scholarship application.
I state that all of the information contained on the attached scholarship application is, to the best of my knowledge,
true and correct. I acknowledge that if any of the information is found to be false and I am awarded a scholarship
based upon such erroneous information, my scholarship is subject to immediate termination and all funds received to
the date of termination shall be returned.
I hereby state that I have read the rules and regulations and that I agree to abide by them in case I win an award.
Moreover, I understand and agree that, if any of the Program’s rules and regulations are violated subsequent to the
awarding of a scholarship, the scholarship shall be terminated and all unused funds shall be returned.
____________________________________
Signature
_____________________________________
Date
IMPORTANT NOTE:
Send this application form, and any correspondence regarding the scholarship competition to:
Laborers Local 582
2400 Big Timber Road, Ste 202B
Elgin, IL 60124
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