Connecticut CPCU Society Chapter, Inc.

SCHOLARSHIP APPLICATION

Applications must be received by April11, 2015.

COVER SHEET

(To be completed by applicant)

Applicant’s Full Name
Residence:
(Street) / (City or Town)
Phone #
Name of Sponsoring CPCU Member:

STATEMENT OF APPLICANT

I, , hereby affirm that I have answered the application questions truthfully and completely.

Applicant’s Signature

Please attach Documents as requested above and in questions on the following pages.

ALL QUESTIONS MUST BE ANSWERED AND STATEMENTS SIGNED, OTHERWISE THE APPLICATION WILL NOT BE CONSIDERED.

This sheet and the requested attachments will be separated from the attached pages once the Scholarship Proctor verifies all documentation. Scholarship committee members will review all validated applicants by the Candidate number assigned below by the Scholarship Proctor.

Return application to:

CPCU Scholarship Committee

C/O Lucy Albetski

20 Hanover Lane

South Windsor, CT 06074

(For Internal use only)

Candidate Number: ______

To be completed by applicant:

1)What recognition have you received in school for scholastic school excellence (e.g. honors, prizes, scholarship)? Attach available documentation.

2)If full time college/high school student, attach school transcript or other proof of grades.

3)Give a brief outline of your immediate education plan:

4)List any extra-curricular activities in which you have taken part (Example: athletics, clubs, yearbook staff, church, civic, fraternal, recreational, charitable or other organizations in which you have been active during the past two years). Mention if you have held office in any such organization and list any special skills or training in any field and how you have applied these skills have or training.

5)What are your vocational intentions at the present time? Please be explicit.

6)Indicate reasons why you feel you deserve to receive this Scholarship. Use separate sheet if necessary.

7)List your employment history. If High School or College, show employment and average hours worked a week.

8)If full time college/high school student, what year are you currently completing?

If high school student, at what schools have you applied for admission, been accepted or are now attending?

9)Projected educational costs for the upcoming school year (less reimbursements/awards from other sources (scholarships, etc. - please be specific):

10)The space below may be used to enter any additional data you may wish to bring to the attention of the Scholarship Committee, including recommendations.

ELIGIBILITY

The Good Works Committee expects to award two scholarships in May 2015, one of which is this special $3,000 Scholarship for Chapter Members.This can change depending upon funds available and the strength of applicants. It is possible that no award will be made in a given year. The award will not exceed the applicant's educational costs (tuition, fees, books, and study materials).
Eligibility is broad. The applicant must be an immediate family member of a Connecticut Chapter member in good standing with the national society and the local chapter. We define immediate family member as child, stepchild, grandchild, sibling, niece or nephewor person for whom the member is a legal guardian. The applicant must be attending or planning to attend a post-high school educational institution of any nature with no restriction on subject matter.

Prior recipients of this scholarship are eligible for a second award.

Non-winning applicants are eligible in subsequent years.

Multiple family members may apply and win.

A volunteer panel of local CPCUs reviews the applications on a name-blind basis. The panels often have favored well-rounded, high-achieving applicants with intentions of pursuing business degrees.