Relationship to Member (son, daughter, parent, partner, spouse, OR Self): *
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Member Full Name (First and Last) *
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Member's Employer: *
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Last 4 of Member Social Security #: *
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Student Mailing Address: (Full Address and City, Zip): *
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I am a member/dependent of UFCW Local 770 in good standing. In order to be eligible for a scholarship, I will remain in good standing from September 2023 through September 2024 and in the Fall will be enrolled as a full-time student (Undergraduate: 12 units or more; Graduate: 6 units or more), in a degree program at any accredited college or university.
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