Irene Mercado Scholarship App. - Cal Feminist FCU

-please print or type-

Name of

Student______________________________________________________

SSN____________________________               (c) 2004 Cal Feminist FCU

Mailing Address______________________________________________

 City ______________________________________State___ Zip_______

 Phone______________________________ Alternate Phone____________________________

E-mail Address_________________________________________________________________

CFFCU  Member’s                     Member’s

Account #_________________    Name______________________________________________

 Applicant’s Relationship to Member_______________________________________

 Please attach a detailed 12-month budget beginning with the month before you will start or return to school and a paragraph of up to 50 words describing how this program will improve your life.  See detailed instructions and deadlines under Scholarship Info .   DO NOT include any other enclosures.

I certify that all information provided is true and correct.  I agree that California Feminist Federal Credit Union may use my name and photograph (which I will provide) for publicity purposes if I am selected as a scholarship recipient.

 ___________________       ______________________________________________

Date                                        Signature

Area/Program/

Type of Study______________________________________    Length of Program__________________________

Start Date_____________________ By what date does school need to receive check?_____________________

School You Plan to Attend____________________________________________________________

School Phone #_______________________________

School Address_________________________________________________________________

 City__________________________________ State________ Zip_____________

Check Payable To_________________________________________________