AFSCME Local 641 Scholarship Application

Applications are available here and at the monthly meetings. The application form must be accompanied by an official transcript of your high school grades (college grades if you are a freshman in college). Selections will be made by the AFSCME Local 641 Executive Board. Please return this completed application and official transcript in a sealed envelope to: Gina Brites, Local 641 Recording Secretary at PRAB-PPS room 220, by May 9, 2026.

 

Applicant’s Name:                                                                                                                                           

Address:                                                                                                                                                          

City, State, Zip Code:                                                                                                                                     

Date of Birth:                                                          Social Security Number:                                                  

Telephone Number:                                               Email Address:                                                                                      

 

  1. Name of AFSCME Member(s):                                                                                                                      

Department:                                                                                        Date Hired:                                    

Relationship to Student:                                                                                                                           

  1. High School/College currently attending:                                                                                                   
  2. List of any activities in which you participated in, during high school or college:                                          

                                                                                                                                                                        

                                                                                                                                                                        

  1. Offices held or honors received, in high school or college:                                                                           

                                                                                                                                                                        

  1. List any activities in which you participated in, outside of school:                                                                 

                                                                                                                                                                        

  1. Offices held or honors received, in these activities:                                                                                       

                                                                                                                                                                        

  1. Future plans:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
  2. List any full-time, part-time, or summer jobs you have held:                                                                                                                                                                                                                                                                                                                                                                                                                     
  3. List colleges you have applied to, and check-off those you have been accepted at:

First Choice:                                                                             Location:                                                        

Second Choice:                                                                       Location:                                                        

Third Choice:                                                                           Location:                                                        

Field of study:                                                                                                                                           

  1. What are the annual costs of the college you expect to attend: 

Tuition:                                     Room:                                     Board:                                    

Additional cost(s):                                                                                                                   

  1. Have you applied for financial aid?                 Yes                  No
  2. Father’s Name:                                                                                                                                               

Address:                                                                                                                                                          

Place of employment:                                                                          Occupation:                                        

  1. Mother’s Name:                                                                                                                                              

Address:                                                                                                                                                          

Place of employment:                                                                          Occupation:                                        

  1. How many people live in your home, including parents?

Number of brothers:                                       Ages:                                                                                       

Number of sisters:                                          Ages:                                                                                       

  1. How many people in your home (including yourself) will be in college in the Fall, 2026?                            

 

**ALL APPLICATIONS MUST BE RECEIVED BY:      MAY 9, 2026**

This application form must be accompanied by an official transcript of your high school grades (college grades if you are a freshman in college). Selections will be made by the AFSCME Local 641 Executive Board. Please return this completed application and official transcript in a sealed envelope to: Gina Brites, Local 641 Recording Secretary at PRAB-PPS room 220, by May 9, 2026.