NAWIC Capital District NY

Personal Information

* Name

* Address

* City

* State

* Zip Code

* Date Of Birth

* Telephone Number

* Cell Phone Number

* E-Mail Address

* Parent/Legal Guardian

Parent Legal Guardian Address (if different from above)

Parent Legal Guardian City

Parent Legal Guardian State

Parent Legal Guardian Address Zip Code

Scholastic Information

CURRENT ACADEMIC INFORMATION

* Please note your anticipated graduation date

* Please list any extracurricular activities you have been involved in for the categories listed below. Indicate elected office held, if any. If not a national organization, also indicate the purpose of the organization. A. Student Activities (i.e. Student Government, Honor Society, etc.) B. Community Activities (Scouts, Volunteer Work, etc.) C. Athletics D. Other

* Official transcript of grades

POTENTIAL ACADEMIC INFORMATION

* Please List colleges to which you have applied and answer the following questions: A. College name B. Address C. Have you been accepted?

* In what program do you expect to receive your degree?

Employment Information

* Parent/Legal guardian Occupation #1 Please select an option, then list occupation below:

Father
Mother
Legal Guardian

* Occupation #1

Parent/Legal guardian Occupation #2 Please select an option, then list occupation below:

Father
Mother
Legal Guardian

Occupation #2

PERSONAL WORK EXPERIENCE

* List employment history below, briefly describing duties and responsibilities. Please include employer name, position and responsibilities

Additional Information

References

*Reference letters must be attached. (See Below)

* Academic Reference - Name of teacher

* Academic Reference - Subject

* Reference Letter Upload Teacher Recommendation

* Personal Reference - Name

* Personal Reference - Occupation

* Reference Letter Upload Personal Recommendation

Construction Questionnaire

*Use only the space provided.

* What area in the construction industry would you like to pursue?

* Why are you interested in a career in the construction industry? What event, or series of events has led you to this decision?

* What has been your most important extracurricular activity? What has been your most important contribution to it? What has your participation in it meant to you personally?

* Are any members of your immediate family presently employed in the construction industry?

Yes
No

* If Yes, please list them below. Please list employer name and relationship

* Describe a personal influence that has lead you into the construction field

* Who has been a female mentor to you, helping shape you as a person? Describe the impact they had on you.

Agreements

* Name I agree that the NAWIC Scholarship Committee of Capital District Chapter 261 of NAWIC may use the application and all attachments for the purpose of evaluation and selection.

* Name Applicant authorizes the Capital District NAWIC to use my name and or photo on website or newspaper publication if selected as scholarship recipient.

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