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Ukrainian
American Veterans
National Scholarship Fund Application
STATISTICAL DATA
Last, First, Middle
2. Mailing Address ______________________________________________
______________________________________________
City, State, Zip
3. Permanent Address _______________________________________________
_______________________________________________
City, State, Zip
4. Telephone: (_____) __________________ Email Address:_________________________________
5. Date of Birth: _____/______/______
6. Place of Birth: ________________________________________________
City, State, and Country
7. Social Security No. _____-____-_______
8. Name of High School: _________________________________________________________
Mailing Address: _________________________________________________________
_________________________________________________________
City, State, Zip
Date of Graduation: _____________________ Class Rank _____ GPA _____
9. Which college, university or institute do you plan to attend? _______________________________
What is your intended Major ___________________________________________________________
10. Name of College, University or Institution: __________________________________________
Mailing Address __________________________________________________
__________________________________________________
City, State, Zip
Expected Date of Graduation: ___________________
Are you a full time student? yes _____ no _____ Number of credit hours _______
Course of Study (Major): ___________________________
Academic Level: Freshman _____ Sophomore _____ Junior _____ Senior _____
11. Marital Status: Single ____ Married ____ Divorced ____ Widowed ____
12. List any awards or honors you have received in school or outside of school:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If more space is needed, please use another sheet of paper and attach it to the application.
13. Did you participate in any school sports? List any awards or letters received.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
14. Did you work after school? Yes _____ No _____
What did you do: ____________________________________________
Employer and dates of employment:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
15. Were you involved in any student activities in school? (Student Counsel, Band, Orchestra, Year Book, Theater, National Honor Society, etc.)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
16. Were you involved in any activities or clubs outside of school? Describe.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
17. List any Ukrainian Organizations of which you are a member.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
18. Did you hold any official position in school or outside of school? Yes _____ No _____
Describe_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
19. Do you have any hobbies? Describe ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
20. Are you a US citizen? Yes _____ No _____
21. Are your Parents deceased? One _____ Both _____ Neither _____
22. Is either Parent a US Veteran? Yes _____ No _____
If yes, which branch of the service? _____________________________________________________
23. Was either Parent killed in military action? Yes _____, No _____
If yes, give details: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
24. Was either Parent disabled in military action? Yes _____, No _____
If yes, give details: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
25. Does either Parent belong to the Ukrainian American Veterans? Yes _____, No _____
If yes, which Post? _______________________
26. Father’s Name: ___________________________
Occupation: _____________________________
Telephone No. ___________________________
Mother’s Name: __________________________
Occupation: _____________________________
Telephone No. ___________________________
27. If neither parent is a US Veteran, who is (Name of Veteran) and tell how you are related.
________________________________________________________________________________________________________________________________________________________________________________________
. 28. How did you hear about the UAV Scholarship? ___________________________________________ ____________________________________________________________________________________________
29. Essay topic: What role or strategy should the United States take in its continued efforts in the war on terrorism (400-500 typed words-double spaced).
30. Please provide a complete transcript of your records (see your principal or registrar) and forward to: Nicholas Skirka, 109 Windsor Terrace, Yonkers, NY 10701-1512.
31. Please submit a wallet size picture of yourself with this application for possible publishing purposes.
Note: The UAV National Scholarship committee is not obligated to return applications, essays, photographs, transcripts, etc.
I accept the aforesaid rules of eligibility and terms of awards hereto annexed and hereby consent to the use of my name, photograph, and personal details that may be used for publication. I certify that all questions, in this application, have been answered truthfully and accurately. Deadline for entry, by the end of August.
Applicant’s signature: ___________________________________________________
Date: __________________________________
You may print this page or for better results download the form in MS Word format by clicking on the following link:
National Scholarship Form
UAV Home Page
Copyright © 2003 by Walter Demetro
of PC HELP L.L.C.,
and the Ukrainian American Veterans, Inc. All Rights Reserved.