CENTRAL PENNSYLVANIA

WATER QUALITY ASSOCIATION

(CPWQA)

SCHOLARSHIP

To parents, guardians and applicants regarding this scholarship application:

This scholarship is for a CPWQA member or immediate family (spouse or child) seeking higher education in an environmental field and is for a maximum of $2,000 and a minimum of $750 scholarship.

Procedures:

The Candidate applying for the environmental scholarship must:

* Complete the application personally

* Enclose only items requested in the requirements (no biographies, resumés, or supplementary lists of activities).

* Answer all questions on the application.  Use only the space provided.

* Attach no more than eight pages to the application (references and high school transcript).

* Include on each attachment the applicant’s name and address.

* Submit all attachments with the application form to ensure that all items are available for review at the same time.  (The CPWQA cannot assume responsibility for matching items that come in separately).

* Address complete applications to:      CPWQA Scholarship Committee

c/o Yves E. Pollart

RETTEW Associates Inc.

2500 Gettysburg  Road

Suite 100

Camp Hill, PA 17011

CPWQA is not responsible for lost or misdirected applications. 

FAXES WILL NOT BE ACCEPTED FOR CONSIDERATION.

* Be advised that only those applications received by April 29, 2005  will be considered.

* Be advised that applications become the property of the selection committee and will not be returned to the applicant. 

* Understand that submitting this application is in no way a guarantee that a scholarship will be granted.

A completed application must contain the following:

ð Application typed or printed in ink

ð Signed CPWQA Scholarship Application

ð Phone number where applicant or parent can be reached with any questions

ð Required signatures on page 1

ð Copy of transcripts and cumulative GPA, including most recent year/term

ð Three (3) reference letters, including contact information for each reference

ð 200-250 word essay explaining why applicant should be considered and discusses applicant’s intended field of study

ð Proof of college/technical school registration or enrollment

Scholarship Selection Process:

The selection committee is composed of CPWQA members.  The committee reviews all applications turned in by the deadline.  The committee will not consider late and/or incomplete applications.  If you have any questions regarding the completion of the application, please feel free to contact Yves Pollart at 717-697-3551.

Each applicant is numerically “scored” based upon the following criteria:

1. Member’s activities with CPWQA

2. Academic accomplishment

3. Activity and involvement in school, work and the community

4. Committee interview (determined by Committee)

The five (5) highest scoring applicants through the first three (3) items above may be interviewed by the committee.  Each applicant’s interview will be ranked and added to the total score of the first three (3) items above to obtain a cumulative score. 

The candidate offered the scholarship must agree to the following conditions before accepting it:

1. CPWQA pays all funds directly to the recipient.

2. These funds are for tuition, room, board and books.

3. The scholarship is limited to use at a college/technical school that offers at least an associates degree upon completion of the course of study offered.

Please be assured that all information will be treated with the strictest confidence. Only members of the CPWQA or their immediate family can apply for this scholarship.

CPWQA SCHOLARSHIP APPLICATION

(Please type or print in ink)

1.  APPLICANT IDENTIFICATION INFORMATION:
NAME
	(Last)				(First)				(MI)
MAILING (HOME) ADDRESS
			(Number, Street and Apartment Number)
			(City)                         (State)						(Zip Code)
TELEPHONE NUMBER
DATE OF BIRTH
SOCIAL SECURITY NUMBER
Father/Guardian Name
Employer							Position
Mother/Guardian Name
Employer							Position
CPWQA Member Name
Applicant’s Affiliation to Member
In submitting this application, I certify that all the information and statements on this form are true and correct.
Applicant		Date				CPWQA Member Sponser				Date
I have read this application and it has my approval.
Father/Guardian Signature				Telephone Number				Date
Mother/Guardian Signature				Telephone Number				Date

2.  CPWQA MEMBERSHIP INFORMATION:
Number of years as a member
List CPWQA Committee served on during membership
3.  APPLICANT SCHOLASTIC AND ACTIVITY INFORMATION
Name of university, college or technical school you plan to attend:
							Accepted? Yes/No
School			Location
Note:  Must provide documentation proof of college/technical school registration
What is your intended major or program of study?
This is a	1 year	2 year			3 year	4 year or longer program of study
This is a graduate study program?				Yes/No
What is your current year of education?
Cumulative GPA including Most Recent Year/Term								GPA
Note:  A copy of the applicant’s most up to date Transcripts must be submitted.

4.  School Activities
Name of high school/preparatory school
Address		City		State			Zip
Principal’s name			Telephone Number			(      )
Other Activities  (check all activities you have been involved in during high school)
Sports	Clubs and Other Activities
ÿ    Baseball	ð    Band/Orchestra				ð    National Honor Society
ð    Basketball	ð    BETA				ð    Student Council/Government
ð    Cross-Country	ð    Choir				ð    Tutoring/Peer Counseling
ð    Football	ð    Chess				ð    Yearbook/Magazine/Newspaper
ð    Golf	ð    Computer				ð    Boy’s State
ð    Soccer	ð    Debating				ð    Future Business of America
ð    Swimming/Diving	ð    Drama/Theater				ð    Future Farmers of America
ð    Tennis	ð    Foreign Language				ð    Students Against Drunk Driving
ð    Track	ð    History				ð    Other (Please specify)
ð    Volleyball	ð    International
ð    Wrestling	ð    Key
ð    Other (Please specify)	ð    Math
	ð    Science
	ð    Model UN
Activities Outside of School
Sports	Clubs and Other Activities
ð    Baseball	ð    Blood Drives
ð    Basketball	ð    Civic (Library, Park, Government Officials, etc.)
ð    Football	ð    Community Theater
ð    Martial Arts	ð    Exchange Student Program
ð    Soccer	ð    Food Drives
ð    Other (Please specify)	ð    4-H
	ð    Hospital
	ð    Junior Achievement				ð    Salvation Army
Church	ð Kiwanas				ð    Scouting
ð    Youth Group	ð    Music				ð    Tutoring
ð    Other (Please specify)	ð    Red Cross				ð    Other (Please specify)
	ð    Rotary