16 The ELEVATOR CONSTRUCTOR IUEC SCHOLARSHIP FUND 2023 – 2024 ACADEMIC YEAR SCHOLARSHIP APPLICATION FORM (U.S.) IMPORTANT: APPLICATION DEADLINE IS JUNE 20, 2023 ■ PART 1. SCHOLARSHIP APPLICANT’S INFORMATION Name, *Last: *First: MI: *Last 4 digits of Social Security Number: *Date of Birth: / / (*At least one - cell phone, email or home phone is mandatory. Provide all three if you have them) Cell Phone: *Email Address: Home Phone: (*All addresses should be street address, not PO Box, at least one address is mandatory) Present Address: City: State: Zip: Home Address: City: State: Zip: ■ PART 2. SCHOLARSHIP APPLICATION IS FOR THIS INSTITUTION OF HIGHER EDUCATION Full Name of School: Degree/Designation Sought: School Address City: State: Zip: ◆ IMPORTANT: YOU MUST ATTACH PROOF OF ENROLLMENT IN THIS SCHOOL FOR YOUR APPLICATION TO BE ELIGIBLE ◆ ■ PART 3. I AM A CHILD OR GRANDCHILD OF THE MEMBER OF THE IUEC NOTED BELOW Name, *Last: *First: MI: His/Her relationship to me (Circle one) Parent / Grandparent *International Union Member No: *Member of Local No: (*At least one - cell phone, email or home phone is mandatory. Provide all three if you have them) Cell Phone: *Email Address: Home Phone: Home Address: City: State: Zip: ■ PART 4. ATTESTATION I understand that any misstatement, omission or misleading information given in this application may result in the rejection of the application and I authorize an investigation into all such information. I understand that any Scholarship Award may be revoked if it is determined that the rules of the Fund have not been fully complied with. I attest all the above information is true, accurate and complete to the best of my knowledge. I also understand that I may be required to submit additional proof of my relationship to the IUEC member. Further, I understand that if I am selected for an award, I may be required to submit documentation supporting the types and amounts of the expenses the award is to be used for, and official verification may be required of my attained grades prior to disbursement of the second installment of my award. ATTESTATION BY YOU, SCHOLARSHIP APPLICANT Signature: Print Name: Date: ATTESTATION BY INTERNATIONAL UNION OF ELEVATOR CONSTRUCTORS MEMBER Signature: Print Name: Date: After completing this Application, postmark (mail) it no later than June 20, 2023 to: IUEC Scholarship Fund 7154 Columbia Gateway Drive Columbia, MD 21046-2132 Attachments and all information provided related to the Application are considered part of this Form. Award monies for the 2023-2024 academic year may be used for any qualified educational expenses (including tuition, fees, course-related expenses, e.g., books, supplies, and equipment) and will not be taxable to you as income. (*) - Mandatory items must be completed / provided to be considered for Scholarship. All other information should be filled in.
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