BLET Auxiliary

Scholarship Application

PLEASE READ ALL REQUIREMENTS AND INSTRUCTIONS BEFORE COMPLETING THIS APPLICATION

ELIGIBILITY: Applicant must be a son or daughter of a BLET Auxiliary member and a Brotherhood of Locomotive Engineer and Trainmen member (living or deceased) with each being a member at least two (2) years and who has been accepted by an accredited school for admission and would like to apply for financial assistance. (Exceptions: Those children in the IWC who do not meet Auxiliary membership requirements and will only be considered for IWC Only scholarships administered by the BLET Auxiliary)

SCHOLARSHIP AMOUNT: $1,000.00

In order to be considered, this completed application must be received by the National Secretary, BLET Auxiliary no later than April 1.

THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS.

Name ____________________________________________________________________________

Address __________________________________________________________________________

_________________________________________________________________________________

Date of Birth ________________________ School Attended ________________________________

Name of Father ________________________ BLET Division ___________________________

Location ____________________________________

Name of Mother __________________________ BLET Local Auxiliary No. _________________ or

Member-At-Large _________________________ Location ________________________________

IWC Scholarship Only Yes _____ No ______

Number of Siblings ______________ Number in College ____________________________

Ages of Siblings _____________________ Name of College(s) ____________________________

IF YOU ARE A HIGH SCHOOL SENIOR COMPLETE SECTIONS 1 & 3

IF YOU ARE A GRADUATE STUDENT AND/OR RETURNING TO SCHOOL, COMPLETE SECTIONS 2 & 3

SECTION 1

NAME OF COLLEGES TO WHICH YOU HAVE APPLIED IN ORDER OF PREFERENCE: Accepted?

_________________________________________________________________ ________

HAVE YOU WORKED WHILE IN HIGH SCHOOL? IF SO, STATE: EMPLOYER, TYPE OF WORK.

______________________________________________________________________________________

HOW HAVE YOU SPENT YOUR SUMMER VACATIONS?

______________________________________________________________________________________

SECTION 2

Married? _________________ Husband’s/Wife’s Occupation? ________________________________

Widowed? ________________ Divorced? _______________ Single? ________________________

Working? __________________ Occupation? ______________________________________________

NAME OF COLLEGE YOU ARE ATTENDING _________________________________________________

Location? City _________________________________ State _______________________________

LAST TERM’S G.P.A. ____________ DATE OF LATEST COLLEGE TERM ATTENDED ______________

(Must be substantiated by Transcripts [official or unofficial] submitted with Application)

SECTION 3

WHAT SCHOLARSHIPS OR GRANTS HAVE YOU APPLIED FOR AND/OR RECEIVED?

1. __________________________________________________________________________________

2. __________________________________________________________________________________

3. __________________________________________________________________________________

Approximate cost per year – TUITION _______________ ROOM/BOARD ____________________

What course of study do you intend to pursue? __________________________ Degree? ___________

REFERENCES:

NAME ADDRESS

1. ____________________________________________________________________________________

2. ____________________________________________________________________________________

COMMENTS BY APPLICANT:

Please attach separate sheet indicating your interests, activities, and a little about yourself.

Organizations you are active in and office held, if any.

______________________________________________________________________________________

Date: ___________________

Signature of Applicant: ___________________________________________

Phone: ______________________________________________

Email Address: _______________________________________

THIS SECTION TO BE COMPLETED BY PARENT OR GUARDIAN

To the best of my knowledge, the information given on this form by the applicant is accurate.

Date _____________________ Signature ________________________________________________

Phone: _____________________

THIS SECTION IS TO BE COMPLETED BY EITHER THE BLET AUXILIARY NATIONAL SECRETARY FOR MALS OR THE LOCAL AUXILIARY SECRETARY**

**If Application is for an IWC only scholarship, please have this Section completed and signed by the BLET Division Secretary/Treasurer

To the best of my knowledge, the information given by the applicant meets respective eligibility requirements.

Date _____________________ Signature: Secretary/ ___________________________________

Treasurer

Phone: ___________________

TO BE COMPLETED BY HIGH SCHOOL AUTHORITIES: Guidance Department (Not applicable to currently attending college or graduate students.)

EXAM SCORES: U.S.A. – SAT Composite _______________

ACT Composite _______________

EXAM SCORES: CANADA – Test Score _______________

RANKING IN CLASS: Sophomore: NUMBER IN CLASS ___________ G.P.A. ___________

Junior: NUMBER IN CLASS ______________ G.P.A. ______________

Senior: NUMBER IN CLASS ______________ G.P.A. ______________

NUMBER OF ADVANCED COURSES: Sophomore _______ Junior _______ Senior __________

REMARKS AND EVALUATIONS: ____________________________________________________

_______________________________________________________________________________

Signature: ________________________________________ Title: ________________________

Printed Name: _____________________________________

Revised January 2010