2016 SCHOLARSHIP APPLICATION APPLICATIONS MUST BE POSTMARKED BY MARCH 1, 2016 ELIGIBILITY TXTA carrier or allied member employee, dependent and/or grandchild High school senior, graduate or equivalent Full-time enrollment at an institution for higher education (12 hours/semester) *Previous scholarship recipients may apply if he/she continues to meet above eligibility standards REQUIREMENTS Applications must be postmarked by March 1, 2016 and include the following: Completed application Recent professional photo (scanned copies not acceptable) Copy of most recent or year-end transcript One to three letters of recommendation from a nonfamilial source Personal narrative (750 words or fewer) Applications should be submitted to: katelyn@texastrucking.com or mailed to TXTA Foundation Attn: Scholarships 700 East 11 th Street Austin, TX 78701 Questions? Call 800.727.7135 x104 The Texas Trucking Association (TXTA) Foundation is a non-profit educational, public relations, research and community service organization created by the TXTA to promote the trucking industry to the people of Texas. TXTA represents more than 800 carriers and allied companies operating in Texas. Drivers, dock workers, mechanics and office personnel are among the thousands of people who contribute to a strong, efficient motor transportation industry in Texas. Many of these workers are, or have dependents, pursuing degrees in higher education or trade schools. The TXTA Foundation would like to help these students in their efforts by providing scholarships to TXTA company member employees, dependents and/or grandchildren. Scholarship recipients will be selected on the basis of their academic achievement, community involvement and financial need. The Foundation will provide financial assistance for university, college and trade school students. Scholarships may be used to meet such expenses as tuition, books and housing. SELECTION AND NOTIFICATION The Board of Trustees is comprised of 15 members. Scholarship recipients are chosen by the Board of Trustees of the TXTA Foundation in May. By submission of this application, the applicant acknowledges that the decision to award a scholarship, the amount of any scholarship awarded and the criteria used to make such decisions is within the sole and absolute discretion of the trustees of the TXTA Foundation. Scholarship funds are mailed directly to the school listed on the application in July after verification of full-time enrollment. Funds are divided equally between the fall and spring semester of the awarded year. Each applicant will receive a notification letter by May 30. Please refrain from calling the Foundation for status updates. Calls after June 6 are welcome if a notification letter has not been received. RECIPIENTS AWARDED SCHOLARSHIPS We are interested in your academic and professional success. The Foundation requests updates from students after each semester and an update as graduation from your school of higher education nears. Please mail updates to the TXTA Foundation scholarship committee at 700 East 11 th Street, Austin, TX 78701, or e-mail to katelyn@texastrucking.com. Page 1 of 7
STUDENT INFORMATION NAME: (Last) (First) (M.I.) (Preferred Name) ADDRESS: (City) (State) (ZIP) PHONE: E-MAIL: DOB: / / SSN: - - GENDER: HIGH SCHOOL: GRADUATION DATE: / / Please check if currently enrolled INTENDED COLLEGE/UNIVERSITY/TRADE SCHOOL: (If undecided, please include all schools in consideration.) Please check if currently enrolled CUMULATIVE GPA: on 4.0 scale 5.0 scale 6.0 scale (Use most recent GPA) ACT SCORE: SAT SCORE: INTENDED MAJOR(S)/AREA(S) OF STUDY: AS OF AUGUST 2016, YOUR STATUS WILL BE: Freshman Sophomore Junior Senior Other: MARITAL STATUS: Single Married Number of Dependents: EMPLOYER: TITLE: SUPERVISOR: SUPERVISOR PHONE: HOBBIES/INTERESTS: ACTIVITIES, AWARDS, VOLUNTEER SERVICE AND HONORS: (Please only include those within the last four years. Do NOT attach additional pages.) ORGANIZATION/TEAM/AWARD # YEARS POSITION HELD COMMENTS Page 2 of 7
FAMILY INFORMATION AFFILIATION WITH THE TRUCKING INDUSTRY: Self Spouse Parent/Guardian Grandparent Name of Relative: Member Company: SPOUSE (Please complete if married/widowed) NAME: LIVING?: Yes No EMPLOYER: TITLE: SUPERVISOR: SUPERVISOR TITLE: PHONE: PARENT/GUARDIAN (Please complete if a dependent) FATHER/GUARDIAN NAME: LIVING?: Yes No EMPLOYER: TITLE: SUPERVISOR: SUPERVISOR TITLE: PHONE: MOTHER/GUARDIAN NAME: LIVING?: Yes No EMPLOYER: TITLE: SUPERVISOR: SUPERVISOR TITLE: PHONE: PERMANENT RESIDENCE: I live at home with my parents I live in a single family household with my Other (Please explain if you live with a guardian, grandparent or have other arrangements) If you checked Single Family Household or Other, please complete the following: Does the non-resident parent contribute to your support? Yes No If yes, amount per year: Comments: During your college career, will any of your siblings also be enrolled in college? Yes No If yes, maximum number enrolled at one time (include yourself): Page 3 of 7
FINANCIAL INFORMATION COLLEGE/UNIVERSITY/TRADE SCHOOL INFORMATION FOR FALL 2016 SEMESTER (If undecided, please include information for all schools in consideration.) INSTITUTION NAME: ESTIMATED TUITION/SEMESTER: _$ (Do NOT include books, room/board, etc.) #CREDIT HOURS/SEMESTER: (Must be enrolled full time minimum 12 hours) ANTICIPATED FINANCIAL SUPPORT PER SEMESTER: $ (From parents, relatives or other non-scholarship, non-loan sources) OTHER SCHOLARSHIPS/LOANS FOR WHICH YOU HAVE APPLIED If you are applying for other scholarships or loans, please list them below. Indicate the status as pending, confirmed or rejected. If pending, please provide the anticipated confirmation date. You may be contacted at a later date to verify approval/denial for any of the below. For scholarships, please include any application you have filled out to be considered for money to be used for any educational expenses. You must provide the total monetary amount of scholarship do NOT put depends or varies. Loans refers to any money that you have applied for or have been given with the intent to pay back. This money could be from a commercial lender, family members or other persons/businesses. SCHOLARSHIP $/YEAR # YEARS TOTAL AMOUNT STATUS CONFIRMATIO N DATE LOANS, GRANT, AWARD $/YEAR # YEARS TOTAL AMOUNT STATUS CONFIRMATIO N DATE ARE YOU A PREVIOUS TXTA SCHOLARSHIP RECIPIENT? Yes No Year(s): ANNUAL HOUSEHOLD INCOME INFORMATION We rely on the integrity of your character to report this information fully and accurately. Your family s adjusted gross income may be found on (or around) line 34 of the most recent U.S. Individual Federal Income Tax Form 1040. Failure to complete this section will result in the loss of any points available for this position of financial need evaluation. All income may be subject to verification through request of annual Internal Revenue Service returns. TOTAL HOUSEHOLD INCOME FOR 2014 TAX YEAR: This includes your annual salary, your spouse (if applicable) and legal guardian(s). < $25,000 $25,000-$50,000 $50,000-$100,000 $100,000-$150,000 $150,000+ Page 4 of 7
PERSONAL NARRATIVE Write a personal narrative 750 or fewer words in the box below containing goals, interests and reason you are applying for this scholarship. Include any unique circumstances or situations that impacted your life or need for a scholarship. It may be typed or hand-written, but MUST fit in the box below. NO ATTACHMENTS WILL BE CONSIDERED. Applications are judged anonymously do not identify the TXTA member company with which you are affiliated. Page 5 of 7
SIGNATURE By submission of this application, I, the applicant, acknowledges that the decision to award a scholarship, the amount of any scholarship awarded and the criteria used to the make such decisions is within the sole and absolute discretion of the trustees of the TXTA Foundation. I, the undersigned, declare that the information provided on this application is accurate and truthful, and understand the TXTA Foundation criteria (high school graduate or equivalent; employee of, grandchild of or a dependent of a TXTA member company in good standing; enrolled as a full-time student). I understand that false statements shall be cause for immediate disqualification of scholarship consideration. Applicant Signature Date CHECKLIST Before submitting your application, please ensure you have included the following: Completed application Official transcript(s) One to three letters of recommendation from non-familial source Recommendation Letter 1 Name: Company/Employer: Job Title: Relationship to Applicant: Recommendation Letter 2 Name: Company/Employer: Job Title: Relationship to Applicant: Recommendation Letter 3 Name: Company/Employer: Job Title: Relationship to Applicant: Recent professional photograph no scanned photocopies Do NOT include additional attachments (i.e. resume, extra pages for Activities, Awards, Volunteer Service and Honors or Personal Narrative sections). INCOMPLETE SUBMISSIONS OR THOSE POSTMARKED AFTER MARCH 1, 2016 WILL RESULT IN IMMEDIATE DISQUALIFICATION. APPLICATION SUBMISSION E-mail to: katelyn@texastrucking.com Or mail to: TXTA Foundation, Attn: Scholarships, 700 E. 11 th Street Austin, TX 78701 Questions? Call 800.727.7135 x 104 Page 6 of 6