The John Rene Rodriguez Memorial Scholarship

The John Rene Rodriguez Memorial Scholarship
Application Form

For UFCW/UL Parent/ Guardian to Complete:
Full Name of UFCW/UL Parent/Guardian:
UFCW/UL Parent Social Security Number:
Local Union Number:
Local Union Address:
Region Number:
Employer Name and Address:
Please Provide additional information that you believe would be helpful to the Scholarship committee in assessing your personal or financial needs:
In submitting the information, I certify that the information is accurate and complete to the best of my knowledge.
Applicant's Signature:

Clear
UFCW/UL Parent/Guardian Signature:

Clear
Please forward the application and all relevant material to:

The John Rene Rodriguez Memorial

Scholarship Fund of United Latinos

c/o UFCW 540

17780 Preston Rd. Dallas, Texas 75252

1-800-282-0714

mona@ufcw540.org
The following sections are being completed in their entirety by the Applican and Parent/Guardian. This application will not be processed without membership verification.

For Scholarship Applicant to Complete:
Name (Last, First, Middle Initial):
Address
City/State/Zip
Phone
Social Security Number:
Sex

MaleFemale
Date Of Birth

MonthDayYear
Date
High School (name and address):
Expected date to start School:

MonthDayYear
Date
Full name of the accredited college, university, trade school, or institution of higher education you have applied to attend (Name):
(City and State)
If you would like to receive a confirmation email, please your type email below:
example@example.com
Should be Empty: