CALIFORNIA-NEVADA SECTION,
American Water Works Association
Education Scholarship Application
(Print out page and mail application)
APPLICANT INFORMATION
1. Name: _____________________________________________________________
Last
First
M/I
2. Address: ___________________________________________________________
Street
____________________________________________________________
City
State
ZIP
3. Phone: _________________ FAX: __________________
Email: _______________
4. Social Security Number: _____________________
5. Name of parent or legal guardian: ________________________________________
____________________________________________________________
Address
City
State
ZIP
6. Are you a previous recipient?
Yes
No If yes, what year? _________
EDUCATIONAL INFORMATION
1. School planning to attend or currently
attending is a:
2-year college
4-year college
School Name: ________________________________________________________
Address: ____________________________________________________________
Street
____________________________________________________________
City
State
ZIP
2. Major field of study: ___________________________________________________
3. Starting Date: ______________
Expected Graduation Date: ______________
4. If you are in college now, what level are you?
Freshman
Sophomore
Junior
Senior
FINANCIAL INFORMATION
1. Present Employer: _____________________________________________________
2. Address: ____________________________________________________________
Street
____________________________________________________________
City
State ZIP
Phone
3. Number of dependents (include yourself) ____
4. Estimated annual income: ____________
5. Estimated financial contributions by applicant: ____________
6. Estimated financial support from parents: _____________
7. List any additional sources of income: __________________________________________
8. Are you the recipient of any other scholarship this
year?
Yes
No
If yes, from whom? __________________________________
Amount $_____________
9. Have you applied for any other scholarships, awards
or grants?
Yes
No
If yes, whom? ____________________________________________________________
Submit application and attachments by June 1, 2006, to:
California-Nevada Section,
American Water Works Association
10574 Acacia Street, Suite D6
Rancho Cucamonga, CA 91730
(909) 481-7200
FAX (909) 481-4688
Attention: Scholarship Program
"I certify that I am a permanent resident in the state
of California or Nevada, and that all of the information in this application
is true to the best of my knowledge."
__________________________________________________
______________________
Signature of Applicant
Date