Foundation Scholarship App

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

	CUNA School or Conference
	Illinois CU League Session
	Certification Course (CCUE)
	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 of Course & Date of Program

2. Amount of Scholarship Funds Requested.

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

3. Name

4. Credit Union

5. Chapter

6. Address

7. City, State, Zip

8. E-mail

9. CU Assets

10. Number of CU Employees

11. Current Position at CU?

Number of Years?

12. Is CU work full or part time?

Full

Part

13. Are you a volunteer at CU?

Yes

No

14. Have you held other positions in this or any other CU? Yes or No (If Yes, list past positions)

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

Yes

No

16. Will you lose vacation / 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. Indicate level of education attainted:

High School

Technical School

Some College

College

19. Have you ever applied for an ICU Foundation Scholarship?

Yes

No

If yes, specify year & course

20. Have you ever recevied a ICU Foundation Scholarship?

Yes

No

If yes, specify year & course

21. How many (#) chapter meetings have you attended during the past year?

Indicate total number of chapter meetings held per year

22. List the chapter or league seminars and conferences you attended during the past 2 years:

23. List any chapter or league offices you have held during the last 2 years:

24. Explain how will this educational program help you and your credit union:

25. Indicate extenuating circumstances relevant to this application:

26. If you receive a scholarship, how much (%) of the balance will be paid by the following:

Credit Union

Chapter

Yourself

Other

27. The following names are required.

Credit Union Officer / Title

Name of Applicant / Date

Please see website or printable application form for details regarding scholarship eligibility requirements.