gucaApplication For College Scholarship Funds

Georgia Utility Contractors Association, Inc.

804 Main Street, Suite C * Forest Park, Georgia 30297-1476

Phone: (404) 362.9995 * Fax: (404) 362.9211

www.guca.com

 

I. PERSONAL INFORMATION

 

NAME _____________________________________________________________________________________________________

 

PRESENT ADDRESS _________________________________________________________________________________________

 

CITY ____________________________________ STATE ________________ ZIP  _______________________________________

 

HOME PHONE  _____________________ WORK PHONE  ______________________ CELL PHONE  ______________________

 

DATE OF BIRTH  ______/ ______/ ______        AGE  _________        SEX  __________

 

MARITAL STATUS  ______________________  SPOUSE'S NAME  __________________________________________________

 

NUMBER OF DEPENDENTS & AGES  __________________________________________________________________________

 

II. EDUCATION

 

COLLEGES ATTENDED (List current college attending first)

____________________________________________________________________________________________________________

Institution                                                                                    City                                                                         State

____________________________________________________________________________________________________________

Institution                                                                                    City                                                                         State

____________________________________________________________________________________________________________

Institution                                                                                    City                                                                         State

 

 

CURRENT YEAR IN SCHOOL                       JUNIOR             SENIOR   
STUDENT CHAPTER MEMBER                   NO                     YES                        DATE JOINED __________________________                 

ANTICIPATED DATE OF GRADUATION (Month/Year) ______________________________________________________________

MAJOR  ____________________________________________________________  OVERALL GPA  ________________________

 

 

III.  FINANCIAL INFORMATION

 

Please indicate below the NET amount of support from the following sources for 2009-2010 school year:

 

WORK __________________________________________ PARENTS/SPOUSE __________________________________________

 

LOANS (Specify)  _____________________________________________________________________________________________

 

OTHER SCHOLARSHIPS ANTICIPATED  ________________________________________________________________________

 __________________________________________________________________________________________

 

OTHER SOURCES OF INCOME (Specify): ________________________________________________________________________

 __________________________________________________________________________________________

 

Describe briefly your estimated expenses for the 2009-2010 school year for the following items:

TUITION  _____________________________________  BOOKS ______________________________________________________

LIVING EXPENSES   __________________________________________________________________________________________

MISCELLANEOUS  ___________________________________________________________________________________________

 ____________________________________________________________________________________________________________

NAME _____________________________________________________________________________________________________

 

IV. WORK HISTORY AND REFERENCES

 

Describe any utility construction industry related work history: __________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

List a minimum of 2 references in the construction industry:

____________________________  _____________________________  _____________________

NAME                                                                          COMPANY                                                                         PHONE

____________________________  _____________________________  _____________________

NAME                                                                          COMPANY                                                                         PHONE

____________________________  _____________________________  _____________________

NAME                                                                          COMPANY                                                                         PHONE

 

V. ADDITIONAL INFORMATION

 

List any professional industry organization(s) and/or associations you are a member of or have participated in:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________

 

VI. CAREER GOALS IN CONSTRUCTION

 

Please indicate your careers goals for construction (if any): ____________________________________________________________               

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Scholarship funds are only available to third and fourth year students preparing for a career in the construction field and who are enrolled full-time. A picture MUST accompany application.

 

I certify that the information given in this application is correct and I have enclosed a copy of my college transcript for the Georgia Utility Contractors Association Scholarship Committee to review. The Georgia Utility Contractors Association Scholarship Committee may use the application and the transcript for the purpose of evaluation and selection.  If awarded, I agree to allow GUCA to use my picture for purposes used to promote the association or the scholarship program.

 

SIGNATURE   __________________________________________________________ DATE  _____/ _____/ _____

 

PRINT NAME   __________________________________________________________________________________

 

 

Georgia Utility Contractors Association, Inc.

804 Main Street, Suite C

Forest Park, Georgia 30297

404-362-9995

www.guca.com

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