ICU Foundation Online Scholarship Application

ICU Foundation Individual Scholarship Application

1. Please indicate from the choices below the type of educational program:

Select a choice

CUNA School or conference
Illinois CU League session
Certification Course
College program
Self Study (STAR/VAP/VLP/Merit
Vendor Sponsored Session
CU affiliated organization session
General computer training or specialized computer class
Other

Please specify title and course and date of program

2. Amount of scholarship funds requested

(max= $2,500 CUNA, $1,000 others)

3. Name

4. Credit Union

5. Chapter

6. Address

7. City, State, Zip

8. Email Address

9. CU Assets

10. Number of CU Employees

11. Current position at CU

Number of Years

12. Is CU work full-time or part-time?

Full
Part

13. Are you a volunteer at the CU?

Yes
No

14. Have you held other positions in this or any other CU?

(If yes, please list past postions)

15. Will you lose all wages while attending this event?

Yes
No

16. Will you lose vacation or personal days while attending this event?

Yes
No

17. Will your chapter or credit union help pay for your tuition/expenses?

Yes
No

If yes, how much (%) is covered?

18. How many chapter meetings have you attended during the past year?

Indicate total number of chapter meetings held per year.

19. How many chapter or league seminars and conferences have you have attended during the past two years?

20. Please list any chapter or League offices you have held during the last two years:

21. Please explain how this educational program will help you and your credit union:

22. Please indicate extenuating circumstances relevant to this application:

23. If you receive a scholarship, who will pay the balance of the expenses related to the program?

Credit Union
Chapter
Yourself
Other

24. The following name and title are required:

Credit Union Officer and Title

Untitled

Name of Applicant and Date

Please see Web site or printable application form for details regarding scholarship eligibility requirements. Thank you for your submission.

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