2026 SCHOLARSHIP APPLICATION FORM

2026 SCHOLARSHIP APPLICATION FORM
MEMORIAL SCHOLARSHIP AWARDSCOMMEMORATING LOUIS L. GRAY - ROBERT M. MOORE - FRANK SCORE
Entrant's Full Name:

First NameLast Name
Entrant's Last 4 Numbers of the SS No.:
Entrant's Phone No.:
Format: (000) 000-0000.
Entrant's Complete Mailing Address:

Street Address, City, State, Zip/Postal Code

Street Address Line 2

CityState / Province

Postal / Zip Code
Entrant's Non-Company Email Address:
example@example.com
College or School to be Attended:
Entrant's Signature:
IF A DEPENDENT OF A MEMBER OF DISTRICT 142
High School Graduating From:
Graduation Date:

MonthDayYear
Date
High School's Complete Address:

Street Address, City, State, Zip/Postal Code

Street Address Line 2

CityState / Province

Postal / Zip Code
D. 142 MEMBER INFORMATION
Full Name:

First NameLast Name
Card or Employee No.:
Employer & Station:
Local No.:
Complete Mailing Address:

Street Address, City, State, Zip/Postal Code

Street Address Line 2

CityState / Province

Postal / Zip Code
Non-Company Email Address:
example@example.com
Phone No.:
Format: (000) 000-0000.
Upload Essay Here:

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EACH SCHOLARSHIP APPLICATION WILL BE PENDING UNTIL VERIFICATION IS RECEIVED
BY THE FINANCIAL SECRETARY OF THE LOCAL
The District 142 Scholarship Committee will communicate with each Local Financial Officer to obtain eligibility verification.
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