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.
Cell Phone*
Please enter a valid phone number.
Age*
Are you interested in a construction industry career?*

YesNo
If not, what career does interest you?
Are any members of your immediate family presently employed in the construction industry?*

YesNo
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?*

YesNo
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*

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

Employment History
Do You Have an Employment History?

YesNo
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?*

YesNo
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)?*

YesNo
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*

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Date*

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Applicant