LOCAL 1904 American Federation of Teachers, AFL-CIO

Dr. Barbara H. Chasin

Montclair State Faculty, Professional Staff and Librarian Association

Department of Sociology

College Hall Room 314A

Dickson Hall 309

Montclair N. J. 07043

Montclair State University

Phone: 973-655-4453; FAX: 973-655-4479

973-655-7224; chasinb@mail.montclair.edu

Dierdre Glenn Paul, President

http:www.aftlocal1904.org -- email union@mail.montclair.edu

The Catherine A. Becker, James P. Keenen III, Joseph T. Moore, Anita E. Uhia, and Connie Waller Scholarship Endowment Fund -- Text Box: Where did you learn of this scholarship: _____ Montclarion ad _____ One of my professors _____ Other students _____ Other source (describe) ____________________ Deadline for Submission: 12 April 2006 by 4:00 pm

APPLICATION COVER SHEET                                     

NAME: ___________________________________________________________

MAILING ADDRESS: _______________________________________________

_________________________________________________________________

HOME PHONE: (       ) ______________ CAMPUS PHONE: (        )_________________                 MSU email address:

STUDENT IDENTIFICATION NUMBER _____________________________

_____ Male

_____ Female

_____ Credits Earned

_____ Undergraduate

_____ Graduate

 

_____ Full-Time

_____Part-Time

_____ Anticipated Year of Graduation

 

 

 

Major________________________

_____________

Minor _________________________

Are you currently receiving financial aid?                                       _____YES        _____ NO
Are you applying for the Ellen Kerns Nunn scholarship?            _____YES        _____NO

Please supply the following as a single and complete package:

1. This cover sheet completed.
2. A three (3) page, double spaced, typed essay written by the applicant that includes a description of:  

a. your economic need

d. any achievements

b. the role of higher education in your life.

e. any community service

c. your career goals

f. how you plan to use the award

3. Two (2) letters of recommendation from a combination of any two of the following members of Local 1904 familiar with you: faculty members, professional staff members, or librarians. Please make sure that you show this form to individuals whom you ask for a reference to insure that they belong to one of these three groups. MSU administrators or adjunct faculty  cannot be members of the Local and therefore recommendations cannot be accepted from them. Download the Recommendation Forms.

4. If you are applying for the Ellen Kerns Nunn scholarship, a notarized statement that you are a working parent supporting at least one dependent child in your household.

I affirm that the information on this application is correct to the best of my knowledge:

Signature ________________________________________Date        ____________________