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THE SOUTHWEST CHEMICAL ASSOCIATION MEMBER SPONSORED SCHOLARSHIP APPLICATION

SECTION I: Personal Data

SWCA Sponsor’s Name:
Applicant’s Full Name:

Permanent Home Address:

Contact Information
Relationship to Sponsoring SWCA Member:
Career Objective:

SECTION II: Educational Institution

Institution's Name:
Full Address:
Academic Major:
Grade Point Average:
Number of Semester Hours to Date:
Hours Presently Undertaking:
Number of Semester Hours Needed to Graduate:
Academic Classification:
Estimated Tuition, Fees, & Books per Semester:

Please list all scholarships you have been awarded including amounts:

SECTION III: Extra curricular activities, Honors/Clubs/Community/School

SECTION IV: Employment Background

Company Position Dates of Employment Hours Worked

SECTION V: Character References

2 References are required. References may NOT be related to applicant.
Reference Name Phone Number
1
2
3

SECTION VI: Statement of Financial Need

 

The undersigned attests to the accuracy of the information provided on this application and understands the SWCA qualification criteria. Applicant specifically authorizes the SWCA Scholarship Committee to substantiate any of the data provided herein. False statements shall be cause for immediate cancellation of the scholarship at any time.

Applicant:
Date:
Signature:
Phone:
SWCA Sponsor:

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