2015 Scholarship Programs
The Northwest Hope Foundation is pleased to announce that this year there will be up to thirteen (13)
Scholarship Awards of up to $2,000.00 each. These awards must be used at an accredited college or
university, technical or vocational school, or junior or community college for any courses of study. The
Scholarship Award is to help pay for tuition, fees, books, educational expenses, and educational materials for
the academic year 2015-2016. If you are interested in pursuing this path, please initial here. _________
In addition to the awards above, The L Walt Derry Scholarship is for those motivated students seeking a career
in the labor movement advancing worker rights and fighting for working families. There will be one
scholarship of $2,500.00 awarded this year. The Scholarship is to offset costs in traditional college and trade
school programs including but not limited to: Human Resources; Labor Relations; Arbitration; Collective
Bargaining; Investigation; Counseling; and Public Relations. If you are interested in pursuing this path, please
initial here. _________
If you want to apply for both, initial here. _________
For
more
information
1-800-452-UFCW.
you
are
encouraged
to
contact
your
Union
Representative
at
You may also contact us at 1 (800) 452-8329 ext. 6354 or send questions to
[email protected].
Eligibility Requirements:
Any full active member of UFCW Local 555 in good standing for at least one (1) year prior to the application
deadline (May 8, 2015) is eligible to apply. A member may also sponsor their child, grandchild, or spouse.
A scholarship application, official high school and/or official college transcripts, an essay of up to 500 words, a
picture (preferred but optional—to be used in publications), and three (3) letters of recommendation must be
received by May 8, 2015 and sent to the Northwest Hope Foundation. Anything submitted in excess of the
above will not be considered. All materials will be judged by the Scholarship Committee. Only the winners
will be notified, and their pictures may be published in the UFCW Local 555 Newsletter.
2015 Scholarship Application
Page 1 of 6
2015 SCHOLARSHIP APPLICATION
Deadline is May 8, 2015
Complete Sections I through V: Please type or print neatly. Include additional pages, if
necessary.
To be eligible to compete for a scholarship, a signed, completed application, your most recent
official high school and/or official college grade transcripts, three letters of recommendation,
and your personal essay must be received no later than May 8, 2015.
SECTION I – APPLICANT PROFILE
Applicant Data:
______________________
______________________
______________________
Last Name
First Name
Middle Name
______________________________________________________________________
Street Address
______________________
______________________
______________________
City
State
Zip Code
( _______ ) ____________ - ____________
______ / ______ / ______
Telephone Number
Date of Birth
____________ -- __________ -- ____________
Social Security Number
UFCW 555 Member:
□ Yes □ No
______________________
How long?
______________________________________________
______________________
Employer Name / Location
Employer Department
2015 Scholarship Application
Page 2 of 6
SECTION II – SPONSOR PROFILE
Sponsor Data:
(If applicant is not a member)
______________________
______________________
______________________
Sponsor’s Last Name
First Name
Middle Name
____________ -- __________ -- ____________
______________________
Social Security Number
Age
UFCW 555 Member:
□ Yes □ No
______________________
Relation to Applicant
______________________________________________
______________________
Employer Name / Location
Employer Department
______________________________________________
______________________
Job Title
Years on the Job
SECTION III – EDUCATIONAL PROFILE
Currently I am enrolled as:
□ High School Senior □ College □ Not Enrolled
_________________________________________________________________________________________
High School
____________________________________________
City / State
___________________________________________
Class of (Year)
□ Public □ Parochial □ Independent □ Military
□ General □ Honors □ Advanced Placement □ Other:
High School Type:
High School:
_____________________________ (specify)
_________________________________________________________________________________________
College Name
____________________________________________
___________________________________________
City / State
Class of (Year)
College Type: □ Public □ Parochial □ Independent □ Military
College Program:
□ General □ Honors □ Advanced Placement □ Other:
__________________________ (specify)
Colleges / Universities To Which You Attend or Plan to Apply:
____________________________________
Name
____________________________________
City / State
____________________________________
Name
____________________________________
City / State
2015 Scholarship Application
Page 3 of 6
____________________________________
Name
____________________________________
City / State
Future Career Plan:
____________________________________
Field
High School or College Activities
List your activities, such as clubs, academic
or athletic teams.
[Sample: Yearbook, Spanish Club]
____________________________________
Job Title
Role / Office
List position or leadership role held, if any.
[Editor, Member]
High School or College Awards
List the full name of academic or school-related
awards and year received.
[Sample: National Merit Scholarship]
Years
List years of
membership.
[12th, 11th, 10th]
Year
Honor Roll / Society
List names and membership years.
[2006]
[Honor Roll 12th, 11th, 10th]
2015 Scholarship Application
Page 4 of 6
SECTION IV – WORK EXPERIENCE
List Jobs Held During High School or College Years or Jobs Held Currently
Employer Name
Job Title
Dates of Employment
From - To
Average Hours
Worked Per Week
SECTION V – COMMUNITY ACTIVITIES
List Community Service Activities Performed During High School or College Years or
Performed Currently (church work, hospital volunteer, community projects, etc.)
Organization Name
Activity
Years of Participation
After finishing school, how will this scholarship enable you to serve your community?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2015 Scholarship Application
Page 5 of 6
SECTION VI – PERSONAL ESSAY up to 500 words
Provide additional information about your goals, hobbies, philosophy, motivations, family, or
any details that would be of value to application evaluators. Include additional pages, if
necessary.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2015 Scholarship Application
Page 6 of 6
I have read and completed this application, provided my official high school and/or official
college grade transcripts, three letters of recommendation, and my personal essay. I certify
that the information is correct and is submitted with my approval, and I authorize the use of
this confidential information by the Northwest Hope Foundation.
______________________________________________
Signature
__________________________
Date
Deadline:
May 8, 2015 (Received)
Mailing address:
Scholarship Committee
Northwest Hope Foundation
P.O. Box 23555
Tigard, OR 97281-3555
Questions:
(503) 598-6354 or 1-800-452-UFCW, ext. 6354
Checklist*:
□ Scholarship Application
□ Official Transcripts
□ Essay up to 500 words
□ Three (3) letters of recommendation
□ Picture (preferred but optional – for use in publications)
* These items will not be returned.