Request to Participate in UFCW Local 1167’s Limited Scholarship Awards Competition

HeadingRequest to Participate in UFCW Local 1167’s Limited Scholarship Awards Competition

Please print your answers below.
I understand that in order to be eligible for a scholarship award:

• I am not eligible for a scholarship offered by the Southern California United Food and Commercial Workers Union and Food Employers Ancillary Benefit Fund.

• Membership on which my eligibility is based must remain in continuous good standing through June 30, 2022. This means the member cannot be suspended, take a withdrawal or transfer to another local prior to June 30, 2022.

• I must be at least a senior in high school.

• I am not eligible to apply if I previously received scholarship award money from UFCW Local 1167.

• If my address, telephone number or place of work changes, it is my responsibility to inform the local union so that I can receive information in a timely manner.

• If the member is involuntarily laid off or transferred out of UFCW Local 1167, I will become ineligible and will notify the local union.

• Finalists will be notified by mail. If I am notified that I qualify as a finalist, I will submit required information and will participate in an interview if invited to do so.

• All decisions of the Scholarship Committee are final.
Applicant Name *
Phone *
Full Home Address *
I am a member of UFCW Local 1167 (circle one)

Yes No
Applicant's Social Security Number *
Type Full Social Security Number
Employed by?
(Only if Member)
Full Store Address *
Union Representative Name
I am related to a member of UFCW Local 1167 (check one)

Yes NO
Relationship to Member
Member's Name
Member's Social Security number
Member Employed by?
Members Company Name
Members Full Store Address
Union Representative
Highest academic level completed by June 2022
Year graduated from high school or month/year will graduate
I applied for a UFCW 1167 Scholarship in (Year applied)
Applicants are not eligible if monies have been receive in the past.)
My cumulative Grade Point Average in High School is/was
(Finalists to confirm with transcripts)
My cumulative Grade Point Average in College is/was
(Finalists to confirm with transcripts)
My cumulative Grade Point Average in GraduateSchool is
(Finalists to confirm with transcripts)
(Signature of Applicant in acceptance of the above) *

Clear
Complete and return by June 30, 2022 to UFCW Local 1167, PO Box 1167, Bloomington CA 92316, ATTN: Shannon
Should be Empty:

HeadingRequest to Participate in UFCW Local 1167’s Limited Scholarship Awards Competition