North Carolina Public School Maintenance Association
District Seven Scholarship Application
A. Applicant
Applicants Name____________________________________ Phone________________________________
Address_________________________________________________________________________________
Date of Birth_____________________ Age_________ Social Security #_____________________________
Applicant Employer________________________________________________________________________
Approximate Salary ______ $0-$20,000 ______$20,001-$30,000
______$30,001-$40,000 ______$40,000+
Current Member of NCPSMA____YES ____NO If YES, how long have you been a member___________
(Please include a copy of qualifying membership card with application).
High School Attending/Attended_____________________________________________________________
Year of Completion______________
College Attending or Applied to and Accepted___________________________________________________
Years Attended____________ or Year to Begin______________
B. If Applicable
Spouse__________________________________________________________________________________
Address (if different from applicant)___________________________________________________________
Employer________________________________________________________________________________
Work Phone Number_______________________________
Approximate Salary ______ $0-$20,000 ______$20,001-$30,000
______$30,001-$40,000 ______$40,000+
Current Member of NCPSMA____YES ____NO If YES, how long have you been a member___________
C. Parent(s) of Applicant if Dependant Child or Adopted Child
Name of Father___________________________________________________________________________
Address_________________________________________________________________________________
Home Phone_____________________________ Work Phone_______________________________
Employer________________________________________________________________________________
Current Member of NCPSMA____YES ____NO If YES, how long have you been a member?___________
Name of Mother___________________________________________________________________________
Address_________________________________________________________________________________
Home Phone_____________________________ Work Phone_______________________________
Employer________________________________________________________________________________
Current Member of NCPSMA____YES ____NO If YES, how long have you been a member?___________
Parents Combined Salaries ______$0-$40,000 ______$40,001-$60,000
______$60,001-$80,000 _______$80,000+
D. NCPSMA Member representing applicant if other then self or parent
Name_________________________________________ Relation to Applicant ________________________ Employer________________________________________________________________________________ Current Member of NCPSMA____YES ____NO If YES, how long have you been a member___________
E. Please list other family members attending school/college, etc
Name College or School Year to Graduate Age
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
F. Finance assistance applied for or received from other sources
__________________________________________________________________________________________________________________________________________________________________
