Scholarship Application

"*" indicates required fields

Please Note: Applications cannot be saved and completed at a later time. An incomplete application will not be reviewed.

SECTION ONE

Name*

First Middle Last

Mailing address*

Street Address City State ZIP Code

Phone*

Email*

Date of Birth*

Your Charter Oak Federal Credit Union Member Number

I am currently a*

High School Student

College Student

Your school*

City/Town where your school is located*

State Where School is Located

State where your school is located

How did you hear about our scholarship program? (choose one):*

If other, how did you hear?

Class rank

Grade point average

If you are under 18, do your parents bank with Charter Oak Federal Credit Union? If yes, please provide their name(s) and member number(s)

Yes

Parent/Guardian Name

Parent/Guardian First Name Parent/Guardian Last Name

Parent/Guardian Member Number

Parent/Guardian Name

Parent/Guardian First Name Parent/Guardian Last Name

Parent/Guardian Member Number

Do you work at Charter Oak Federal Credit Union?

Yes

Do any of your relatives work at Charter Oak Federal Credit Union?: If yes, please list them below.

Yes

Name

Charter Oak Employee First Name Charter Oak Employee Last Name

Name

Charter Oak Employee First Name Charter Oak Employee Last Name

Name

Charter Oak Employee First Name Charter Oak Employee Last Name

What college will you be attending this Fall? If undetermined, please list your top school choices below.

College

School location*

City State

College 1

City State

College 2

City State

College 3

City State

College 4

City State

College Student - check box if:

I currently attend the college listed above

I'm interested in the following career or industry

Activity #1

Hours per week