NUCANF Scholarship Application
Appl. # _________
FOR UNDERGRADUATE/GRADUATE COLLEGE STUDENT
Applicant must complete this form. Sign this sheet and have a parent or guardian approve the application.
Answer all questions. If a question doesn’t apply, write “none” in the space provided.
NAME OF APPLICANT:
First
Middle
Last
STREET ADDRESS
CITY, STATE,ZIP
HOME PHONE
DATE OF BIRTH:
NUCANF MEMBER FIRM:
MOTHER’S NAME:
FATHER’S NAME:
WHICH PARENT IS AN EMPLOYEE OF THE NUCANF MEMBER FIRM?
APPLICANT CHECK LIST






General Information
Academic Information
Extra -Curricular Information
Essay (500 words or less)
Current College Transcript (Signed by Student Advisor)
Letter of Recommendation from a Faculty Member.
I certify the information herein is complete and accurate to the best of my knowledge and belief.
_____________________________________
_____________________________________
Signature of Applicant
Date:
1
Appl. # ___
General Information
Name and address of high school:
Year of High School graduation:
Name and address of college:
Anticipated Graduation Year:
Major:
2
Appl. # ___
Academic Information
College GPA:
List SAT and/or ACT College Board Examination Scores: (Scores not appearing in your official transcripts
may be submitted if attested by a high school official.)
1.
2.
3.
College Academic Honors Received (awards, prizes or distinctions). Please include applicable year.
Extra-Curricular Information
College activities/clubs (list separately with years involved and office held, if any)
College Sponsored Athletic Programs
(List separately with years involved)
3
Appl. # ___
Community Service/Civic Groups
(List separately with years involved)
Special recognition received:
Hobbies and outside interests:
Work Experience
Describe any work experience. How long did you work there, what were your responsibilities, and what did
you do with your earnings?
What has your work experience taught you?
Describe any extraordinary responsibilities you have at home or any information you think may be relevant
for the judges to see.
4
Appl. # ___
ESSAY
500 words or less
(Provide as an attachment)
You have just been invited to speak at the White House. Write your speech.
Essay must be printed or typed.
AUTHORIZATION
Should you be selected to receive the NUCANF Scholarship, we would like your permission to include
portions of your application and your essay in our scholarship book which is available for members to
review, and in various association communications and publications. Your signature below will indicate
your approval.
______________________________
Signature of Applicant
Please return your completed application along with pertinent information no later than June 1, 2015 to:
NUCANF Scholarship Committee
12842 Huntley Manor Drive
Jacksonville, FL 32224
5