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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 __________________________________________________________________________________________________________________________________________________________________
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