NATIONAL AUXILIARY SCHOLARSHIP APPLICATION

NATIONAL AUXILIARY SCHOLARSHIP APPLICATION
Choose which scholarship you are applying for:*
I. Personal Information
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your immediate family size?*
Name of a Parent or Guardian*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian Email*
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List Any Family Who Are Currently Members or Who Have Been Members of the PHCC-National Association (include full names and estimated number of years as a member)
II. School Information
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Contact*

First NameLast Name
Department (This should be the department you want the check sent to for Financial Aid/Scholarships.)*
Student ID*
Date of Enrollment*

MonthDayYear
Date
III. Sponsor Information

(PHCC National Auxiliary member for 2 years who is NOT a parent, guardian, or spouse)
Sponsor Name*

First NameLast Name
Sponsor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor Phone*
Please enter a valid phone number.
Sponsor Email*
example@example.com
IV. Career Information
What are your future education plans? *
What career do you intend to pursue?*
What are your career goals?*
Employer Info (Fill out if employed by PHCC National Association Member – Required for Bradford White Scholarship):
Company Name
Position/Title
Manager's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
How does the Plumbing, Heating, Cooling, Refrigeration industry relate to your work and life?
V. Scholastic Information
For High School Students/Students Attending First Year of College:
High School Attended/Attending
Year of Graduation
Rank or Percentile in Class
Cumulative GPA
SAT or ACT Test Score
Principal Name

First NameLast Name
For Current College/Trade/University Students
College/Trade/University Name
Dean or Advisor Name

First NameLast Name
Undergraduate Major(s)
# of College Credits Earned to Date
Cumulative GPA
Expected Date of Graduation

MonthDayYear
Date
Degree You Will Receive
VI. Activities
What school activities are/were you involved in and when? Indicate NONE, if not involved in school activities.(Example: Debate team – Jr & Sr years high school; Basketball team – 2nd and 3rd semesters in 10th grade.) *
What community activities have you been involved in and when? Indicate NONE, if not involved in community activities.*
Please list any awards you have received. Indicate NONE, if no awards were received.*
Please list your work experience – this includes volunteer work and unpaid/paid internships. Indicate NONE, if no work experience.*
VII. Applicant's Signature
By signing this form, you give us the right to use your photograph in the announcement of the winners.

I hereby certify that the above is true and accurate.
Signature*

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Parent/Guardian Signature (if under 18 years of age)

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Upload proof of enrollment here*

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Upload recommendation letter here*

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Upload letter from sponsoring Auxiliary member here*

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Upload transcripts and exam score documentation here*

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NATIONAL AUXILIARY SCHOLARSHIP APPLICATION

I. Personal Information

II. School Information

III. Sponsor Information

IV. Career Information

V. Scholastic Information

VI. Activities

VII. Applicant's Signature