Application 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