2005 Winter Issue 2.45 MB - the American Water Works Association ...

HAWAII SECTION AWWA
2006 Scholarship Application Form
1. Name: ________________________________________ Social Security No. ____________________
Permanent Home Address: _______________________________________________________________
City: _______________________________________ State: ___________Zip Code: ________________
Bus. Phone: __________________________ Res. Phone: ______________________________________
2. Name of Member if you are a dependent: __________________________________________________
3. Name and location of College/University for which this scholarship will be used: ______________________
____________________________________________________________________________________
Curriculum/Major/Course: _______________________________________________________________
Year in school: ( ) Freshman ( ) Sophomore ( ) Junior ( ) Senior ( ) Graduate
( ) Other: __________________________________________________________Full Time: ( ) Yes ( ) No
Date of entry into College/University: _______________________________________________________
4. Other College/Universities attended (Indicate full time or part-time):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
5. List three references (other than relatives):
NAME ADDRESS PHONE NO.
________________________ _______________________________________ ___________________
________________________ _______________________________________ ___________________
________________________ _______________________________________ ___________________
6. Please attach a transcript of grades for your two most recent school years.
7. Please submit a letter to the Scholarship Committee covering the following:
a. Reason for desiring a scholarship. Indicate to what expense award will be applied.
b. Academic interest and vocational plans, including any plans for graduate work.
c. Interests, hobbies, activities, memberships and offices held.
d. Employment: Major work since high school graduation; type of work, name of employer, address, full
time or part-time; values and disadvantages.
e. Any other information you feel may assist the Committee in making a decision.
I HEREBY DECLARE that all statements on this application form and attachments are correct and complete.
__________________________________ __________________
Signature
Date
Received by:
__________________________________ __________________ _______________
Signature Date Title
Submit application & attachments to:
SCHOLARSHIP COMMITTEE
AWWA/Hawaii Section
c/o Department of Water Supply
345 Kekuanaoa Street, Suite 20
Hilo, Hawaii 96720
Attention: Larry Beck
All applications must be received by March 17 (Friday), 2006 for consideration.
10 AWWA/Hawaii Section Winter 2006