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PHILADELPHIA CHAPTER CPCU SOCIETY

SCHOLARSHIP GRANT APPLICATION

N.B. YOU MAY PRINT THIS FORM AND USE IT FOR YOUR APPLICATION

ELIGIBILITY

To be eligible the applicant must:

1.

  1. Be employed in the insurance industry in the Philadelphia Chapter territory or employed in the insurance industry elsewhere but reside in the Philadelphia territory: or
  2. Be the spouse, child, stepchild, grandchild, dependent, brother or sister of a person who is either employed in the insurance industry in the Philadelphia Chapter territory or employed in the insurance industry elsewhere but reside in the Philadelphia territory, or an active member of the Philadelphia Chapter: and

2. Be enrolled at an accredited two or four year college or university in a full time associate’s degree or bachelor’s degree program; and

3. Not have been awarded this scholarship in the past. Prior unsuccessful candidates may re-apply.

PHILADELPHIA CHAPTER TERRITORY:

The Philadelphia Chapter territory is comprised of the city of Philadelphia, the four surrounding counties, southern New Jersey and the state of Delaware.

INSTRUCTIONS FOR APPLICATION

The application consists of the following:

  1. A completed scholarship application.
  2. Transcript of high school or college grades as of the end of the current school year as indicated in the table that follows. Transcripts should cover at least the prior two academic years and all college work.
  3. A copy of the Scholastic Aptitude Test (SAT) scores. Please note in Section 14 of the application if you were not required to take the SAT.
  4. A letter of recommendation from the persons listed in Section 11 of the application sent under separate cover to the address below.

SUMMARY TABLE OF REQUIREMENTS FOR APPLICANTS

Freshman

Sophomores

Juniors

Seniors
Completed Application

X

X

X

X
High School Transcript

X

      
College Transcript – all schools  

X

X

X
SAT Scores

X

      
Letters of Recommendation

X

X

X

X

All of the above materials should be sent to the address below by May 1st of the year in which the scholarship is to be awarded. Please do not staple materials together. All applicants will be notified of the results in June.

Richard J. Lee, CPCU

C/o DVIT

Philadelphia CPCU Scholarship Fund

1015 N. York Rd.

Willow Grove, PA 19090

 

  

 Page 1 of 4

  1. About the applicant:

    Name: __________________________________________________

    Residence: Street: ________________________________________________

    City: ______________________ State: ____ Zip: ______________

    Date of birth: __________ Home phone: _____________ SS#: ______________

        2.  About family member (or self) currently employed in the insurance industry:

    Name: __________________________________________________

    Residence: Street: ________________________________________________

    City: ______________________ State: ____ Zip: ______________

    Employer information:

    Name of employer: _________________________ Business phone: __________

    Street: ____________________________________________________________

    City: ____________________________ State: _____ Zip: ___________

     

3.        School presently attending and your status (freshman, sophomore, etc.)

    School: ___________________________________ Status: __________________

4.    What recognition have you received in school for scholastic excellence (i.e. honors, awards, etc.)?

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

     

    5.Do you believe that your present and recent grades in high school and/or schools of advanced education reveal fairly                                                               and accurately your ability to do the work required at a higher level? If not, explain.

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

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6.  List any extra curricular activities in which you have taken part. (Examples: Athletics, Clubs, Yearbook staff, etc.)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

7. List any church, civic, fraternal, recreational or other organizations in which you have been active during the past two years.

Mention if you have held office in any such organization.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

  1. Have you any special skills or training in any field? If so, provide a brief description.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

9. What are your career goals at the present time? Please be explicit.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

  1. Indicate reasons why you feel you deserve this scholarship.

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    __________________________________________________________________________

    Page 3 of 4

11. List below the name of a person who knows your academic record well and/or an active CPCU sponsoring you whom you have asked to send a letter of recommendation to the Selection Committee.

    Name: ___________________________ Street: ___________________________________

    City: ____________________________ State: _____ Zip: ___________

    CPCU Name: ______________________ Street: __________________________________

    City: ____________________________ State: _____ Zip: ___________

    12.    List any employers and average number of hours worked per month during your school years.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

        13. At what schools have you applied for admission, been accepted or are now attending?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

14. The space below may be used to enter any additional data you may wish to bring to the attention of the Selection Committee.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

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I hereby affirm that I have completed this entire application and that I have answered the foregoing questions truthfully.

Date: __________________ Signature of Applicant: _________________________________

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