LOCALS 175 & 633 MCKAY-THOMPSON-HOEBINK-GIBSON SCHOLARSHIP APPLICATION FORM
Applicant Information
First Name:
Last Name:
E-mail:
Permanent Home Address:
City:
Province:	Select... Ontario Northwest Territories Nunavut Quebec Newfoundland Prince Edward Island Nova Scotia New Brunswick Manitoba Saskatchewan Alberta British Columbia Yukon
Postal Code:
Telephone:	()   -
I am a member of UFCW Local 175 or 633
I am the of a UFCW Local 175 or 633 member If applicant is not a member, specify relationship of applicant to member here (i.e. son, daughter or spouse)
UFCW Local 175 or 633 Membership Information
Member's First Name:
Member's Family Name:
Member Since:	Select year...195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009
Employer:
Unit #:	(if applicable)
Education Information
My last completed year of schooling was . The school I last attended was . I will be studying in a program at (post-secondary institution).
Field of study:
Academic Year:
From:	Select month...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember    Select year...20092010201120122013
To:	Select month...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember    Select year...20092010201120122013
Expected cost of tuition:
I hereby certify that the above information is correct.
Date: 03-07-2009.