Scholarship Application – Bi-State Motor Carriers

Student Information

Last Name
First Name
Middle name
Address
City
State
ZIP
Date of Birth
Phone
Email

School Information

Current School Name
Address
City
State
ZIP

Criteria and Eligibility

Expected/Actual Graduation Date
Current GPA (min 2.5)
SAT Score
ACT Score
Approximate Annual Household Income**

**Our scholarship is not purely need-based, and is not strictly based on academics. Please provide any information on unusual hardships or financial circumstances separately. This information will be kept confidential to protect your privacy

Member Company Authorization

Sponsor's Name
Job Title
Relationship to Applicant
Bi-State Member Company*
Authorized Company Officer Name
Officer's Email
* Company must be an Association Member-in-good-standing for a minimum of six months by the application deadline in order to be eligible. The Association of Bi-State Motor Carriers Scholarship Committee reserves the right to verify all information provided. Applicant's personal information will be kept confidential. All decisions of the Scholarship Committee are final.

Affirmation

I hereby affirm that all of the information provided by me is true and correct to the best of my knowledge. I also consent that if I am the award recipient, my picture may be taken and used for promotional purposes. I hereby understand that if chosen as a scholarship winner, I must provide evidence of enrollment/registration at the postsecondary institution of my choice before scholarship funds can be awarded. I understand that failure to attend an accredited two-year or four-year college or university or at an accredited vocational/technical institution within 120 days of receiving this award will result in forfeiture of the scholarship funds.
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