JAKE JACOBSON SCHOLARSHIP APPLICATION FORM

ASLRRA is awarding 10 railroad training scholarships, thanks to a generous donation from the family of the late Jake Jacobson.

Scholarships of $500 each are available to employees of small railroads, defined as those earning $10 million or less in annual revenues. Scholarships must be used for ASLRRA hosted training in safety, compliance or leadership development. ASLRRA railroad members meeting the revenue criteria across the U.S. are encouraged to apply.

Scholarships will be awarded to qualified candidates on a rolling basis until all funds are distributed. Applicants will be contacted by an ASLRRA representative if additional information is required and once an award decision is made.

APPLICANT NAME

First NameLast Name

APPLICANT TITLE

APPLICANT PHONE

Area CodePhone Number

APPLICANT EMAIL

example@example.com

EMPLOYER (RAILROAD) NAME

EMPLOYER (RAILROAD) ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ORIGINAL DATE OF HIRE AT RAILROAD

Date

PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR ROLE AND RESPONSIBILITIES AT THE RAILROAD.

NAME OF SUPERVISOR OR RAILROAD HUMAN RESOURCES CONTACT

First NameLast Name

SUPERVISOR TITLE

SUPERVISOR PHONE

Area CodePhone Number

SUPERVISOR EMAIL

example@example.com

DESIRED ASLRRA TRAINING PROGRAM

TRAINING PROGRAM DATE(S):
Date TO Date

PLEASE INCLUDE ANY CERTIFICATIONS YOU WILL RECEIVE OR EXPECTED TAKEAWAYS.

ADDRESS WHERE TRAINING WILL BE HELD (If virtual, please state "VIRTUAL" in street address line)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PLEASE PROVIDE A BRIEF STATEMENT ABOUT WHAT YOU EXPECT TO LEARN AT THE TRAINING EVENT AND HOW THE TRAINING WILL HELP YOU IN YOUR JOB.

Scholarship recipients will be reimbursed $500 for the course registration fee. Copies of receipts and documentation of course completion, including any certifications earned, must be provided.

Scholarship recipients agree to participate in a brief interview and provide on-the-job photos that may be published in an issue of ASLRRA's e-newsletter, featured on the association website at aslrra.org, and/or included in other print and electronic materials.

Please label and attached supporting materials.

Browse Files

ASLRRA JAKE JACOBSON SCHOLARSHIP FORM