Scholarship Application

Scholarship Application
Applicant

Please complete all sections of this application. Use N/A if question does not apply. Appearance and completeness will be considered during evaluation.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Age
Are you interested in a construction industry career?
If not, what career does interest you?
Are any members of your immediate family presently employed in the construction industry?
Name
Relationship
Employer
Position
Are any members of your immediate family a member of any of the Connecticut Bricklayers and Allied Craftsman’s Local Unions?
Name
Relationship
International Membership #

School Character Evaluator

This is the person who will receive the evaluation form after scholarship submittal.
Teacher/Professor Name

First NameLast Name
Email
example@example.com
Personal Character Evaluator

This is the person who will receive the evaluation form after scholarship submittal.
Family/Friend Name

First NameLast Name
Email
example@example.com

Scholastic Information
Provide names, city and state of secondary schools you have attended or are currently attending. Most recent first. Be sure to indicate month and year of Graduation.

Education

Rows	High School College/University	Attended (From-To)	Anticipated Month & Year of Graduation
1
2
3
4

Employment History
Do You Have an Employment History?
List below full-time employment, summer employment or other part-time work. Briefly explain duties and responsibilities (beginning with the most recent job). If part-time work, indicate number of hours per week.
Company 1 (Date Range)
xx/xx/xxxx - yy/yy/yyyy
Company 1 (Firm's Name)
Company 1 (Type of Business)
Company 1 (Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 1 (Position)
Company 1 (Duties)
Company 1 (Salary)
Company 1 (Supervisor's Name)
Would You Like to Add a Second Company?
Company 2 (Date Range)
xx/xx/xxxx - yy/yy/yyyy
Company 2 (Firm's Name)
Company 2 (Type of Business)
Company 2 (Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 2 (Position)
Company 2 (Duties)
Company 2 (Salary)
Company 2 (Supervisor's Name)

Financial Information
What percent of your college education and living expenses do you expect to provide?
Brothers & Sisters in family "older" than you.
Brothers & Sisters in family "younger" than you
Including yourself, how many members of your immediate family will be in college next year?
How many are receiving financial assistance in the form of scholarships or grants?
Do you have a Pell Grant (Basic Federal Loan Program)?
If yes, amount?

Costs

Income

Additional Information
What has been your most significant non-academic activity, your most important contribution to it and what has your participation in it meant to you?
I agree that the application and all attachments may be used for the purpose of evaluation and selection by the Board of Directors of the Mason Contractors Association of Connecticut and/or its representative designated by its Board of Directors.
Signature
Date

MonthDayYear
Date
Should be Empty:

Applicant