NAME:
Social Security Number:
Address:
City/Town: Zip: / Zip/Postal Code: Country:
Daytime Phone: Email:
Name of school you attend or will attend: / Major:
If you have a relative in the onsite wastewater treatment system industry please give name and relationship.
Many professionals working in the wastewater industries are members of NAWT. NAWT is a national association that focuses on maintaining a unified voice of the industry, a leader in education, and projecting a positive public image. We provide information and educational opportunities to the working professionals in the industry.
The 2014 Hapchuk Scholarship task is to:
“Create and design a slogan or a bumper sticker representing NAWT, and then write a 250-500 word essay of why you think NAWT should choose your slogan/bumper sticker.”
Applications must be postmarked by January 1, 2014.
All applications for scholarship must be completed by you, the applicant, and returned, if by postal service or email with the form to the NAWT office.
Applicant’s signature: / Date Submitted:
NAWT William Hapchuk Memorial Scholarship
Art Work and Design Creation
Waiver Form
I, (Print Name) ______
Hereby grant permission to NAWT to use my artwork and slogan created for the William Hapchuk Memorial Scholarship exclusively and I give up any future claims and rights to submittedartwork and slogan created. NAWT has the right to use the artwork and slogan created in any way deemed appropriate, for education or promotional purposes. Furthermore, the submitted artwork and slogan created is my original work and does not infringe on any current copyrighted work or produce a likeness of work by anyone but myself.
[ ] I understand what I have read above and agree to the terms therein.
(Initial the box if you agree)
Date: ______
Signature: ______
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