United BOCES Teachers Association
Scholarship Application
The recipients of this scholarship must:
 Be the son or daughter of a United BOCES Teachers Association
member.
 Your mother or father must be a dues paying member of UBTA (not
an agency fee payer).
 The recipient must be finishing their senior year of high school.
 The recipient must be planning to enter a higher education program
in the fall. (Any type of higher education.)
Completed applications are due by Friday, April 15th 2016.
The applications will be reviewed by a committee of 3 or more union
members who do not have children applying for the scholarship.
The application consists of three parts:
 Part I—Background information
 Part II—Personal Statement
 Part III—Honors received and extracurricular activities
 Part IV (Optional) – Parent Statement
The application may be printed and completed by hand and mailed or it
may be completed on the computer and sent electronically to the address
below. Parts I-II must be entirely completed. Part IV is an optional
submission. Please remember neatness, spelling and little things like
complete addresses do count.
Any questions from parents or completed applications can be sent to my
(Lynn Bergreen’s) e-mail address at:
phlutieflake@aol.com
Please return your application by April 15th 2016 to:
Lynn Bergreen
22 Oak Street
Allegany, NY 14706
DO NOT WAIT UNTIL THE LAST MINUTE TO TURN THIS IN!
United BOCES Teachers Association
Scholarship Application
Part I
Name:
Address:
Parent employed by BOCES:
My mother
father
is a dues paying member of the
United BOCES Teachers Association and is assigned to
.
(List the BOCES Center or Division/School)
My parent is employed as a
.
(Type of classroom, subject, other position.)
Name of other parent:
School Information
High School:
Guidance Counselor’s Name:
College attending:
Course of study:
Length of program:
Full
or Part-time
Estimated cost of program per year: (tuition, books, room, board,
transportation, and misc. expense):
PART II
A typed personal statement (200 words about yourself), include
educational goals, occupational goals, and life goals on a separate sheet.
PART III
Honors Received and Extra-Curricular Activities
(You may find it easier to use your own format, as long as it is neat and complete.
Add some details about what makes you outstanding/deserving of this scholarship.)
What school organization(s) have you been involved in and for how many years?
1.
5.
2.
6.
3.
7.
4.
8.
What offices have you held?
1.
2.
3.
4.
5.
6.
What sports have you participated in and for how many years?
1.
4.
2.
5.
3.
6.
What honors have you received?
1.
2.
3
4.
5.
6.
What out-of-school organizations and/or community service have you been involved in?
1.
4.
2.
5.
3.
6.
WORK EXPERIENCE
1.
2.
3.
4.
5.
6.
PART IV
Parent Statement (Optional) – A typed statement to describe your child –
his/her strengths, challenges, what makes him/her special and deserving of
this award.