About the Applicant:

Full Name: *
Home Street Address: *
Home/Cell Number: *
E-Mail: *
Date of Birth: *
Social Security Number: *
Academic, Leadership, Athletic or Employment Awards or Recognition You Have Received/Community Service You Have Provided (List):

Applicant's Academic Background:

Name of High School: *
School Address: *
School Phone Number: *
Cumulative Grade Point Average: *
Date of Graduation: *

Parental/Guardian Information:

Applicant's Name: *
Please select one of the following regarding your Parent/Guardian: *
Deceased/Disabled Parent’s Name: *
Parent’s Date of Death or Disability: *
Deceased/Disabled Parent’s Employer: *
Employer’s Street Address: *
Employer’s Phone Number: *
Contact Name at Employing Firm/Agency: *
Surviving Parent/Legal Guardian’s Name: *
Full Address: *
Phone Number: *

Information on School to Which Scholarships Will Be Applied:

Name of School to Which You Will Apply Scholarship:
Street Address: *
Phone Number: *
Has this School Accepted You for Admission? *
Begin Date of Attendance: *
Select your academic level for the 2016-2017 school year: *
Major: *
Expected Graduation Date: *
If you are already in college, what is your cumulative Grade Point Average? *
What is the school’s cost of attendance for full-time enrollment for two semesters (one academic year)? *
Where do you plan to live?: *
Approximate Cost of Room and Board (one year): *

Required Documents:

Acceptable file formats for uploads are: pdf, doc, docm, dot, jpg, gif, png. If a file you are attempting to upload is different than those listed above, please contact webmaster@artba.org
An official copy of the applicant’s transcript and grade report from the school currently attended or most recently attended. A minimum, cumulative academic performance of at least a 2.5 on a 4.0 scale is required for consideration. 
At least two letters of recommendation from teachers in support of the candidate’s application. Additional letters from a school administrator, counselor, clergy, work or military supervisor, who can address the qualifications and academic aptitude of the applicant, may also be submitted in support of the candidate, although they are not necessary for consideration. Do not send letters of recommendation from immediate family members, close family friends, blood relatives, or relatives by marriage. 
attach second recommendation.
Proof of parent’s death in line of duty. (This may be a newspaper clipping with a date the article appeared, a letter from the deceased parent’s former employer, etc.). If parent is permanently incapacitated, submit appropriate documentation, including, but not limited to a physician certification form stating that the injury was directly related to on-duty job-site injury or documentation from the Social Security Administration disability insurance program. Must show that disability was work-related, along with a statement of injury from employer. *
A typewritten statement, no longer than 200 words, prepared by the applicant that explains his/her reasons for wanting to continue his/her education. For previous scholarship recipients, please provide a reflection on how the scholarship has affected you and your family, and your future educational goals. The personal statement must be updated every application year. *
A recent high quality photo of yourself. Electronic photos are preferred. Files must be 300 dpi or higher and in full-color JPEG, TIFF, or PDF format of less than 15MB. *
A completed and signed “Free Application for Federal Student Aid” (FAFSA) forms for the current year. The FAFSA can be obtained at school guidance offices or via the Internet at www.fafsa.ed.gov. *
Applicant must provide a copy of his/her most current year’s federal tax return and a copy of parent’s most current year federal tax return. *
A copy of the acceptance letter from the college, university, technical school, etc. where the applicant plans to attend. *
A statement providing the approximate cost of annual tuition and room and board to attend school where scholarship will be applied. *

Electronic Signature:

I certify that all the information provided in this application is accurate to the best of my knowledge. I understand that providing false or misleading information on this application will result in forfeiture of any scholarships that may be awarded. Disclosure I also acknowledge that by applying for the ARTBA-TDF Lanford Family Highway Worker Memorial Scholarship and providing copies of my personal statement and photograph, I am granting permission for ARTBA-TDF to use my statement and photographs for scholarship-related publicity and promotional purposes.