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

I understand that in order to be eligible for a scholarship award:

1. Applicants must establish basic eligibility by applying for a scholarship award and completing the “Request to participate in UFCW Local 1167 College (university or junior college) Scholarship Awards Competition” applica- tion published in this newspaper at the right of this announcement or online. The application must be returned to UFCW Local 1167 no later than Tuesday, February 28, 2023.

2. Those eligible to compete are current active members of the local not eligible to apply in the above-described Benefit Fund Scholarship Program, their spouses and their dependent children. Dependent grandchildren of dues-paying retirees are eligible. Sisters, brothers and non-dependent grandchildren are not eligi- ble.

3. Applicants must be at least seniors in high school.

4. Applicants are not eligible if they previously received UFCW Local 1167 Scholarship Award monies.
5. To be eligible, the member must be in continuous good standing for at least one year through April 30, 2023. The member whose eligibility is used cannot be suspended, take a withdrawal or transfer to another local. Failure to comply with these eligibility rules disqualifies the applicant.

6. Winners are selected by the Scholarship Committee based on: • Academic record
• Leadership record
• Community service and volunteer activities

• Character and personality

• Personal achievement

7. Awards will be made to undergraduate or graduate applicants at the sole dis- cretion of the local’s Scholarship Committee.

8. Finalists selected by the Scholarship Committee must provide proof of aca- demic record and submit completed forms (blank forms to be provided by the union) listing leadership activities, community service and volunteer activities and personal achievements, substantiated by two teachers, and two personal recommendations.

9. Finalists may be required to participate in a personal interview.

10. Awards are contingent upon the student being accepted by, registered at and attending an accredited academic institution. Vocational school students may also apply.

11. Winners must be full-time students taking at least 12 undergraduate or nine graduate units, or part-time working students taking six undergraduate or four graduate units.

12. Decisions of the Scholarship Committee are final.

Applicant Name*

Phone*

Full Home Address*

I am a member of UFCW Local 1167 (circle one)

YesNo

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)

YesNO

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

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