ROBERT SHAW MEMORIAL SCHOLARSHIP

Associated Builders and Contractors of Iowa Apprenticeship & Training Trust AND Davenport Evening Optimist

2016-17 Scholarship Application Form

Scholarship application due by February 28, 2017

INSTRUCTIONS TO APPLICANT: Complete the first page of the application yourself. Please type or print. Give a complete home address. Then give the form to your employer for completion of the second page. Your employer will mail the completed application.

Name Age______Gender: F M

Apprenticeship Level for 2016-17 year Last 4 digits of your Soc. Sec. No. –

Year graduated from high school or passed GED

(must provide documentation of high school graduation or GED)

Home Address Home Phone (______)

email

City State

Zip ______

Employer

Please provide a one-page explanation (typed) of your educational and career goals. Make sure you attach it to this form.

I understand that by submitting this application I am placing myself under consideration for the Robert Shaw Memorial Scholarship through Associated Builders and Contractors of Iowa Apprenticeship & Training Trust.

Signature______Date______

Scholarship application due by February 28, 2017

This side to be completed by Employer

Please type or print

I recommend ______(apprentice) for the Robert Shaw Memorial Scholarship.

I verify that ______(apprentice) does not receive full tuition or book fee reimbursement from my company, nor does my company fund their full apprenticeship training.

(employer) pays % of our apprentice’s tuition and ______% of book fees.

I further verify that the applicant is a resident of Iowa, living within 100 miles of the Quad Cities.

Name______Position______

Signature______Date______

Employer: Please mail or FAX or email completed form by February 28, 2017:

Ginny Shindelar

ABC of Iowa Apprenticeship & Training Trust

3100 SE Enterprise Dr.

Grimes, IA 50111

FAX: 515-986-1479

email:

MAKE SURE THE FOLLOWING ARE INCLUDED:

·  Documentation of high school graduation or GED

·  One-page statement from the apprentice

·  Both sides of this form completed

The Associated Builders and Contractors of Iowa Apprenticeship & Training Trust requests this information in order to consider the applicant for the Robert Shaw Memorial Scholarship. No information from this form is released to any persons outside of the Apprenticeship Trustees. All applicable information must be provided. Failure to provide full information may result in the disqualification of the applicant.

Page 2 of 2