2018 J. H. BUDDY RASPBERRY SCHOLARSHIP FINANCIAL ASSISTANCE APPLICATION

Transcription

1 2018 J. H. BUDDY RASPBERRY SCHOLARSHIP FINANCIAL ASSISTANCE APPLICATION BASIS OF ELIGIBILITY Due Mnday, April 16, 2018 NO EXCEPTIONS The J.H. Buddy Raspberry Schlarship Fund is ffering an additinal schlarship up t $15,000 per awarded year fr ecnmically disadvantaged individuals. Fund schlarships shall be granted nly t Eligible Persns wh (1) are children f Emplyees, spuses f Emplyees, grandchildren f Emplyees, r Emplyees and (2) meet the minimum standards fr admissin t a pst-secndary educatinal institutin. An Eligible Persn will be in the grup f ptential Fund schlarship grantees withut regard t the psitin r duties f the Emplyee. An Emplyee is defined as every active r retired individual wh has wrked an average f at least 700 hurs per year in the West Gulf regin f the United States during the last three years f active emplyment fr an Emplyer. An Emplyer is defined as a regular r affiliate member f the West Gulf Maritime Assciatin that emplys I.L.A. labr pursuant t a cllective bargaining agreement; the Prt f Hustn Authrity; the West Gulf Maritime Assciatin; the Suth Atlantic & Gulf Cast District f the Internatinal Lngshremen s Assciatin, AFL-CIO; r any f its lcal unin affiliates perating in the west Gulf. Because selectin f the recipient is based n financial need, yu must prvide detailed financial infrmatin. Page 2 f this applicatin is t be cmpleted by the Emplyee wh is the basis fr the applicant s eligibility. APPLICANT INFORMATION Name: Last First Middle Hme Address: City State Zip Cde Phne #: ( ) - Date f Birth: / / Scial Security #: - - Applicant Name: Page 1 f 10

2 ILA/COMPANY EMPLOYEE INFORMATION Name: Last First Middle Emplyee s Hme Address: City State Zip Cde Phne #: ( ) - Date f Birth: / / Scial Security #: - - Check the apprpriate bx fr yur invlvement in the maritime industry: wrker under the ILA WGMA cllective bargaining agreement in the west Gulf emplyee f the Prt f Hustn Authrity emplyee f the fllwing maritime cmpany: emplyee f the Suth Atlantic & Gulf Cast District, I.L.A. r lcal unin affiliate I have the fllwing relatinship t the applicant: self parent grandparent guardian spuse THIS SECTION TO BE COMPLETED BY ILA OFFICIAL OR COMPANY MANAGEMENT: I verify that the abve named emplyee is an active r retired individual wh has wrked an average f at least 700 hurs per year in the West Gulf regin f the United States during the last three years f active emplyment fr an Emplyer. An Emplyer is defined as a regular r affiliate member f the West Gulf Maritime Assciatin that emplys I.L.A. labr pursuant t a cllective bargaining agreement; the Prt f Hustn Authrity; the West Gulf Maritime Assciatin; the Suth Atlantic & Gulf Cast District f the Internatinal Lngshremen s Assciatin, AFL-CIO; r any f its lcal unin affiliates perating in the west Gulf. By: Signature (ther than abve emplyee) Print Name ILA Lcal r Cmpany Name Applicant Name: Page 2 f 10

3 FINANCIAL INFORMATION Sectin A. Persnal Financial Infrmatin Instructins: In this sectin, please prvide infrmatin regarding yur persnal financial situatin Wuld yu be able t attend yur schl f chice withut any financial assistance? Are Yu: a) married b) divrced c) separated d) single e) widwed (circle ne) I. List yur fur largest mnthly expenses: ITEM COST PER MONTH II. Are yu currently respnsible fr supprting family members r thers? If s, list the persns and amunt f mnetary supprt per mnth: FAMILY MEMBER/OTHER PERSON SUPPORT PER MONTH III. List any emplyment btained. Submit an additinal sheet, if necessary, using this frmat. Dates (start with mst recent) Place f Emplyment Include Name f Supervisr & Phne N. Jb Duties/Hurs Wrked Amunt Earned Per Week Applicant Name: Page 3 f 10

4 IV. What is yur current ttal balance f cash, savings and checking accunts? $ (Prvide either a bank statement, letter frm financial advisr r parents. Please bscure accunt numbers) V. What is the current net wrth f yur investments? $ (Prvide statement frm Investment Cmpany, financial advisr r parents. Please bscure accunt numbers) Sectin B. Family Financial Infrmatin Instructins: In this sectin, please prvide infrmatin regarding yur family s financial situatin Are Yur Parents: a) married b) divrced c) separated d) single e) widwed (circle ne) VI. With whm d yu currently live: a) bth parents b) ne parent c) ther (circle ne) VII. VII. Hw many peple are in yur husehld including parents, siblings, r ther children? List primary jb, with cmpany name, fr the fllwing persns, if applicable. If unemplyed, nte this and prvide mst recent jb. If emplyed at hme, list type f hme-based business: TYPE OF EMPLOYMENT (JOB TITLE) Father Mther Guardian (if nt parents as listed abve) Spuse PLACE OF EMPLOYMENT IX. Wh f the abve prvides yur principal financial supprt? X. What is the ttal balance f cash, savings and checking accunts fr the persn circled? $ (Prvide either a bank statement, letter frm financial advisr r parents. Please bscure accunt numbers) XI. What is the current net wrth f the investments f the persn yu identified? $ (Prvide either a bank statement, letter frm financial advisr r parents. Please bscure accunt numbers) Applicant Name: Page 4 f 10

5 XII. What specific financial circumstances shuld be taken int cnsideratin when reviewing yur applicatin fr this award (prvide any pertinent supprting dcumentatin)? XIII. Are there any extenuating circumstances that shuld be cnsidered? Submit an additinal sheet if necessary. DECLARATION: I, declare that all infrmatin cntained in this applicatin is true, t the best f my knwledge, and I hereby authrize the J.H. Buddy Raspberry Schlarship Cmmittee t investigate all facts n this applicatin. I understand that deliberate false statements will result in the immediate rejectin f this applicatin and revcatin f any future awards frm the J.H. Buddy Raspberry Schlarship Fund. (THIS APPLICATION MUST BE NOTARIZED) SIGNED: DATE: NOTARY ACKNOWLEDGEMENT State f Texas Cunty f Subscribed, Swrn and acknwledged befre me by, and subscribed and swrn t befre me by the witnesses belw, this the th day f, 20. Ntary Signature In and fr the Cunty f _, State f Texas My cmmissin expires: Applicant Name: Page 5 f 10

6 ACADEMIC INFORMATION Instructin: If yu are a current high schl student, please cmplete Sectin A befre cntinuing t the next page. If yu are currently in a cllege, university, trade schl, r vcatinal prgram, please cmplete Sectin B befre cntinuing t the next page. Sectin A. Current High Schl Student. Attach a high schl transcript as well as a cpy f the fficial scre sheet fr the SAT r ACT (applicable nly if applying t a fur (4) year institutin) and cmplete the fllwing: SAT: ACT: Math Verbal Cmpsite Scre Writing (if taken) Writing Schls Applied T: Date Applied: / / Date Applied: / / Date Applied: / / Date Applied: / / Planned Majr, Trade, r Vcatin: Sectin B. Currently Enrlled in a Higher Educatin Prgram. Attach an fficial transcript and cmplete the fllwing: Current Majr, Trade, Vcatin, r Accreditatin: All applicants must include recmmendatins frm at least tw educatrs. Vcatinal applicants must include at least tw emplyer recmmendatins. PLEASE NOTE UP TO EIGHT (8) SCHOLARSHIPS ARE DESIGNATED FOR TRADE SCHOOL OR VOCATIONAL PROGRAMS INCLUDING ACCREDITATION PROGRAMS. Applicant Name: Page 6 f 10

7 VOLUNTEER ACTIVITIES List any extracurricular activities, including any psitins held, such as President, Secretary, etc. Submit an additinal sheet, if necessary, using this frmat. Dates (list mst recent first) Activity Mst Significant Cntributin HONORS AND SCHOLARSHIPS Submit an additinal sheet if necessary, using this frmat. Mnth/Year Spnsr Name f Award Basis f Award Applicant Name: Page 7 f 10

8 ESSAY: Discuss yur cnnectin t the maritime industry, yur majr area f study, and the ccupatin yu prpse t pursue after graduatin. What are yur lng term gals, and hw d yu hpe t achieve them? The essay may als include any ther infrmatin that is relevant t yur career plans. The essay shuld be typed with n mre than 500 wrds, duble-spaced. APPLICATION CHECKLIST Cmpleted applicatin with the required signatures and verificatins Dcumentatin prviding persnal financial infrmatin Dcumentatin prviding family s financial infrmatin Recmmendatins f at least tw educatrs Recmmendatins f at least tw emplyers (required fr vcatinal applicants) Essay (maximum 500 wrds) Official High Schl Transcript (current high schl senirs nly) Cllege Transcript (applicable t currently enrlled cllege students) Trade/Vcatinal Prgram Transcript (current vcatinal applicants) Accreditatin Prgram Certificate r verificatin f hurs (if applicable) SAT/ACT Scres (current high schl students nly) Be sure yur name appears n each page including all attachments APPLICATION MUST BE COMPLETE IN ORDER TO BE ELIGIBLE FOR CONSIDERATION Applicant Name: Page 8 f 10

9 J. H. BUDDY RASPBERRY SCHOLARSHIP FUND 1717 Turning Basin Drive, Suite 200 Hustn, Texas ACADEMIC RECORDS RELEASE AUTHORIZATION Applicant s Name: Grade: I, the undersigned, authrize my schl fficials t release infrmatin abut my academic recrds t the J. H. Buddy Raspberry Schlarship Fund. I understand that the schl recrd will becme the cnfidential prperty f the J.H. Buddy Raspberry Schlarship Fund. (Applicant s Signature) (Date) Applicant Name: Page 9 f 10

10 Mail yur cmplete applicatin package t: J.H. Buddy Raspberry Schlarship ATTN: Judith Brwn 1717 Turning Basin Drive, Suite 200 Hustn, Texas Applicatin must be received by Mnday, April 16, 2018, NO EXCEPTIONS. NOTE TO APPLICANT: In the event yu are awarded a schlarship, the maximum amunt f the award fr the academic year is $15,000. The schlarship amunt may be applied t tuitin, institutinal fees, and bks (if applicable) nly. The schlarship recipient is respnsible fr ntifying the J. H. Buddy Raspberry Schlarship Fund f their tuitin and fee bill. The J. H. Buddy Raspberry Schlarship Fund will pay a maximum f $7,500 after receipt f the first semester tuitin and fee bill. An additinal award, with a maximum f $7,500, is awarded after receipt f the recipient s first semester grades and secnd semester tuitin and fee bill. Payment is sent directly t the schlarship recipient. Applicant Name: Page 10 f 10