Foundation Scholarship Application / Credit Union Educational Scholarships / Purpose / Home

Course Title *

Date of Program *

Location of Program *

Amount Requested *

Credit Union Name *

Name * First Last

Federal Employer ID # *

Please enter a whole number only for your Federal Employer ID# (without a dash).

Credit Union Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Email *

Credit Union Phone * - (###) - ### ####

Credit Union Position *

Employment Type * Full Time Part Time Volunteer

If you are a Volunteer, what is your full-time occupation?

Length of Credit Union Service *

Please enter a whole number only for your Length of Service.

Credit Union Assets *

Please enter a whole number only for Asset Size (without commas).

Number of Credit Union Employees *

Please enter a whole number only for your Number of Employees.

Brief Description of Credit Union Duties *

Offices held in credit union, chapter, League, or national association: *

Will you receive assistance from your credit union? * Yes No

If yes, in what amount?

Will you lose wages while attending the conference? * Yes No

Have you attended the conference in previous years? * Yes No

Have you ever received an SECUF scholarship? * Yes No

If yes, specify year & course:

Briefly Explain Your Need for Financial Assistance:

Name of credit union manager to contact for approval of this scholarship application submission: *

Phone Number of Approving Manager: * - (###) - ### ####

Email of Approving Manager: *

Legal Disclosure * I certify that the information provided on this application and all supplemental forms is complete and correct to the best of my knowledge. I further certify that if I am chosen as a scholarship recipient, I will use those funds only for the purposes which the scholarship is offered and if asked, will provide documentation showing such. I will provide a summary of what I learned and how I will apply it to improve the credit union.