2009 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
processing. Incomplete applications will be
returned!
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PERSONAL DATA

APPLICANT’S NAME: _____________________________________________________SEX: ____ M ____ F

HOME ADDRESS: _________________________________________________ CITY: ________ ZIP:_______

E-MAIL, IF AVAILABLE: _____________________________ SS#: ___________________________________

PHONE: ____________________________________________________________________________________

MOTHER OR LEGAL GUARDIAN’S NAME: _____________________ OCCUPATION: _________________

HOME ADDRESS________________________________ CITY: _________________________ ZIP:_________

FATHER OR LEGAL GUARDIAN’S 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 _________________________________________________________________________________________

_________________________________________________________________________________________

____________________________________________              ______________________________________
PARENT’S OR LEGAL GUARDIAN’S SIGNATURE            APPLICANT’S 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 SECRETARY-TREASURER – 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 JANUARY 31, 2009.

MAIL APPLICATION TO: TEXAS AFL-CIO EDUCATION DEPARTMENT
P. O. BOX 12727, AUSTIN, TEXAS 78711





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