The Lanford Family Highway Worker Memorial Scholarship Program The Lanford Family Highway Worker Memorial Scholarship Program Foundation Safety Certification Board of Trustees Scholarship & Awards Industry Leader Development Program Hall of Fame Student Video Contest Transportation Builder Institute Donate Contact Email: Eileen Houlihan About the Applicant:Applicant Name* First Last Applicant Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* 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* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code School Phone Number*Cumulative Grade Point Average*Date of Graduation* Parental/Guardian Information:Parent/Guardian Name* First Last Please select one of the following regarding your Parent/Guardian*DeceasedDisabledDeceased/Disabled Parent’s Name* First Last Parent’s Date of Death or Disability* Deceased/Disabled Parent’s Employer*Employer’s Street Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer’s Phone Number*Contact Name at Employing Firm/Agency* First Last Surviving Parent/Legal Guardian’s Name* First Last Surviving Parent/Legal Guardian’s Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Information on School to Which Scholarships Will Be AppliedName of School to Which You Will Apply Scholarship*School Phone Number*School Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Has this School Accepted You for Admission?*YesNoBegin Date of Attendance* Select your academic level for the 2017-2018 school year*FreshmanSophomoreJuniorSeniorMajor*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?*On-campusOff-campusCommute from Parents HouseApproximate Cost of Room and Board (one year)*Required DocumentsAcceptable 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 jrussell@artba.orgOfficial Copy of the Applicant’s Transcript and Grade Report*Accepted file types: pdf, doc, docx, rtf, jpg, png.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 considerationTwo Letters of Recommendation From Teachers* Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx, rtf. 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. Proof of Parent’s Death in Line of Duty Drop files here or Accepted file types: jpg, gif, pdf, png, doc, docx. 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 employerTyped Reasons for Wanting to Continue Education (200 words)*Accepted file types: jpg, gif, pdf, png, doc, docx, rtf.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.Photo of Yourself*Accepted file types: jpeg, tiff, pdf, png, jpg.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.Free Application for Federal Student Aid FormsA 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.Federal Tax Return* Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. 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.Acceptance Letter from School*Accepted file types: jpg, gif, png, pdf, doc, docx.A copy of the acceptance letter from the college, university, technical school, etc. where the applicant plans to attend.Room and Board, Tuition Statements*Accepted file types: jpg, gif, pdf, png.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.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. By Markus Proctor|2019-03-28T16:20:17+00:00October 19th, 2017|Comments Off on The Lanford Family Highway Worker Memorial Scholarship Program Share This Story, Choose Your Platform! FacebookTwitterLinkedInRedditGoogle+TumblrPinterestVkEmail About the Author: Markus Proctor
