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Academic Scholarship Year 2016-2017
Posted On: Feb 17, 2016

Request full copy of The James R. Hoffa Memorial Scholarship Fund 2016-2017 Academic Year Scholarship Application by e-mail send request to Local1129@att.net

THE JAMES R. HOFFA
MEMORIAL SCHOLARSHIP FUND
2016 – 2017 Academic Year Scholarship Application
Application due date: Thursday, March 31, 2016
James R. Hoffa became a Teamsters Member in 1934, served as General President for 14 years, and, in recognition of his tireless
service to the union, was honored as General President Emeritus for life. At the November 1999 General Executive Board
meeting, then-General Secretary-Treasurer C. Thomas Keegel presented a resolution to establish the James R. Hoffa Memorial
Scholarship Fund.
The James R. Hoffa Memorial Scholarship Fund awards scholarships annually to outstanding high school seniors. All applicants
must comply with the following eligibility and application criteria.
SCHOLARSHIP INFORMATION:
1. DEADLINE for receipt of scholarship applications is Thursday, March 31, 2016. (NO EXCEPTIONS).
2. Type or print legibly. Illegible applications will be returned to you.
3. If you have any questions about the application, please call the JRHMSF Administrative Manager at (202) 624-8971 or by
email at scholarship@teamster.org.
4. Please provide enough time for your Local Union, System Federation or BLET National Division to receive and complete the
attached membership verification form. If the above institutions are unable to verify membership then please send your
application straight to the Scholarship Office and we will provide membership verification.
The James R. Hoffa Memorial Scholarship awards scholarships on the basis of a comprehensive process. Areas that are reviewed
by the Scholarship Committee include, but are not limited to the following: Academic Accomplishments, Community Service,
Letters of Recommendation (if a Canadian or Puerto Rican applicant), and Financial Need. The scholarship awards are paid
directly to the schools.Scholarship winners are awarded either a $10,000.00 award split up over four years at $1,250.00 per
semester, or a one-time $1,000.00 award. Winners of the $10,000.00 award will have their scholarship renewed each year,
pursuant to the Scholarship Renewal guidelines, and must maintain a GPA of 3.0 (B average) or higher.
SAT & ACT Codes
1. SAT – 0518
2. ACT - 0670
ELIGIBILITY REQUIREMENTS
1. Be the son, daughter or financial dependent (this does not include spouses) of a Teamster member (hereafter also referred to as
“Teamster Member Relation”) who qualifies (or in the case of retirees, has qualified)* as a member in “continuous good
standing” in the Teamsters Union as defined in Article X, Section 5 of the International Constitution;
2. Be in his/her last year of high school and may not apply if he/she has already graduated from high school;
3. Be in the top 15% of his/her high school class;
4. Plan to submit excellent SAT or ACT scores for evaluation (U.S. only);
5. Plan to attend an accredited four-year college or university within the United States or Canada, as a full-time student. Those
who plan to attend non- academic or certificate programs or community college may not apply.
*To qualify as a retired Teamster Member Relation, the Member Relation must demonstrate that he/she was retired from a craft represented by his or her Local Union and was a
member in “good standing” as per Article X, Section 5 of the International Constitution for 5 years prior to his/her retirement.
* A seasonal employee eligible to vote pursuant to Article XXII, Sec. 4(c) of the International Constitution, shall also qualify as a Teamster Member Relation.
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Application Process
SCHOLARSHIP APPLICANTS MUST PROVIDE:
• Completed application form.
• Official high school transcript in a sealed envelope from the institution.
• Demonstrated financial need.
• Homeschool applicants MUST take the SAT II for eligibility.
• Canadian and Puerto Rican applicants ONLY must also provide three letters of recommendation in lieu of SAT/ACT
scores. Two academic letters (from a teacher, principal, etc), and one personal letter (from an employer or neighbor, NOT
a family member or yourself). If you are not a Canadian or Puerto Rican applicant and you submit letters of
recommendation, those letters will not be considered.
• SAT II test scores are required for all applicants if the applicant’s class rank is not available.
SCHOLARSHIP AWARDS
• Finalist notification will be given by June 2016 via email.
• Winner notification for $1,000.00 “Bootstrap” winners will be notified via email and $10,000.00 winners will be notified
via email and mail by July 2016.It is VERY important that you provide an email address that you check frequently. In
addition, please ensure that “@teamster.org” emails are placed on your non-spam/junk list.
• Awards will be disbursed to the schools by August 2016.
• Winners must be ready to provide their student ID, the correct mailing address of their institution and the department
where their scholarship check is to be received, upon notification of award.
Deadline for the application is Thursday, March 31, 2016. Applications must be received by this date or will not be considered.
Please email the application as one PDF to scholarship@teamster.org OR it can be faxed to (202) 624-7457, or mailed to
the following address:
James R. Hoffa Memorial Scholarship Fund
25 Louisiana Ave NW
Washington, DC 20001
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APPLICATION
Must be filled out by Applicant and Teamster Member Relation.
Name:
Last ______________________________________ First ___________________________________ Middle Initial ____
**Required**
Social Security Number (United States) ______________________
OR Social Insurance Number (Canadian) ______________________
Address:
Street ____________________________________________________________________________
City, State, Zip or Postal Code ________________________________________________________
Contact Information:
Home Phone # ________________________ Alternate Phone # ________________________________
E-Mail Address (IMPORTANT) _________________________________________________________
Sex:
? Male
? Female
Date of Birth: ______________
mm/dd/yyyy
High School
___________________________________________________________________________________________________
Name and Address
Expected Date of High School Graduation ___________ 2016
month
Canadian Students:
In 2016, I will complete _______ Junior Matriculation
_______ Senior Matriculation
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Name(s) of the Accredited College(s) Applied to or Plan to Attend:
1.
________________________________________________________________________________________________________
Name City and State
2.
________________________________________________________________________________________________________
Name City and State
Teamster Affiliation (If any of this information is incorrect this will delay your application process):
? IBT
? BMWED
? BLET
? GCC
? TCRC
Local Union/Division # ____________
Local Union Address ________________________________________________________________________________
Please check box if you are a seasonal employee:
? Seasonal Employee
Full Name of Teamster Member Relation (NOT Self) _________________________________________________
Teamster Member Employer Name ___________________________________________________
Employment Address _______________________________________________________________________________
Occupation _____________________________________________________
Teamster Member Relation’s Social Security/Insurance Number OR Ledger ___________________________________
Teamster Member Relationship to Applicant (NOT Self) ________________________________
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ESTIMATED FINANCIAL NEED
*If you are not sure of your financial need yet, please provide a brief explanation explaining your situation.
Total Anticipated Amount of Need for One (1) School Year
(tuition, room and board, transportation, and books) $ ____________
Financial Aid or Scholarships Received or Applied for:
Source: _____________________________
Source: _____________________________
Source: _____________________________
$ ____________
$ ____________
$ ____________
Additional Funds:
Parental Assistance
Employment
Gifts
$ ____________
$ ____________
$ ____________
Net Amount Needed (subtract all funding from total
anticipated amount) $ ____________
Please provide any additional information that you believe would be helpful to the Scholarship Committee in assessing your
personal or financial need:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________
STATEMENT OF ACCURACY
I hereby affirm that all the above stated information provided by me to the James R. Hoffa Memorial Scholarship Fund Committee
is true, correct and without forgery. Incorrect information provided may result in disqualification of the application and even
subsequent rescission of a scholarship award, if applicable.
Signature of scholarship applicant: ________________________________ Date: _______________________
Teamster Member Relation: ______________________________________ Date: ________________________
The deadline for this application to be received by James R. Hoffa Memorial Scholarship Fund is
Thursday, March 31, 2016. No exceptions!
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ACTIVITY SHEET
Please list the following information on a separate sheet if needed.
SCHOOL EXTRA-CURRICULAR ACTIVITIES: Please list school extra-curricular activities in which you have participated,
beginning in high school. Note leadership roles and dates.
COMMUNITY SERVICE/VOLUNTEER ACTIVITIES: Please list community service or volunteer activities that you have
been active in, beginning in high school. Note leadership roles and dates.
WORK EXPERIENCE: Please list any work experience you have, beginning in high school. Note leadership roles and dates.
HONORS, ACHIEVEMENTS AND DISTINCTIONS: Please list any honors, achievements and distinctions you have
received, beginning in high school. Note dates.
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CHECKLIST
*Please review and check off all boxes to ensure that you have completed this application.
? Completed entire application including Social Security/Insurance number
? Completed the Activity Sheet
? Completed the Financial Need
? Attached Official Transcript OR has noted that an Official Transcript will be sent separately
? Attached Official SAT/ACT/SAT II Scores OR has noted that they will be sent separately. ALSO, if your official scores
are on your official transcript, you have noted this on the application
? FOR CANADIAN AND PUERTO RICAN APPLICANTS – Attached three letters of recommendations, pursuant to
the requirements for types of recommendation letters
? Completed the Membership Verification form by providing the form to the Local Union, System Federation or BLET
National Division.
? Signed “Statement of Accuracy” by both Applicant AND Teamster member relation.
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ACADEMIC RECORD
Must be completed by the Applicant’s high school official– Please note that if your school does not have rank or GPA, then
please provide an explanation and provide any information that you would provide to the college to which the student is applying.
Applicant’s Name:
_____________________________________________________________________________________________________
Last First Middle
High School Information:
Name of Secondary School _________________________________________________________________________________
Address _______________________________________________________ Phone # __________________________________
NOTE:Please check the box if homeschooled:
? Homeschool
Class Rank (If information is left blank WITHOUT an explanation, then student’s application will not be processed):
a. Please indicate the student’s exact or approximate rank in class.
Student ranks exactly/approximately __________ in a class of ___________ students at the end of __________.
mm/yyyy
b. If exact rank is not available, please provide:
Class size _________ Decile/Percentile __________
c. Indicate if student has taken SAT II in lieu of class rank:
? SAT II (Scores Attached)
Grade Point Average (If the school does not provide GPA please provide a general estimate or explanation):
Please indicate the student’s un-weighted grade average in the spaces below. (MUST be on 4.0 scale).
Student has the un-weighted GPA of ______ at the end of __________.
mm/yyyy
Honors, Advanced Placement (AP), or other Advanced Classes
THE JAMES R. HOFFA
MEMORIAL SCHOLARSHIP FUND
9
Please indicate if you are taking advanced courses:
? Honors
? Advanced Placement (AP)
? Other Advanced Classes
High School Transcript
Please attach an official transcript bearing the school’s seal or principal’s signature to this application. Please note that the
transcript is to be cumulative of the applicant’s grades over the course of high school.
Test Scores
A. SAT Scores:
Critical Reading __________ Math ___________ Writing ___________ Total ___________ Test Date ____________
mm/yyyy
Critical Reading __________ Math ___________ Writing ___________ Total ___________ Test Date ____________
mm/yyyy
Critical Reading __________ Math ___________ Writing ___________ Total ___________ Test Date ____________
mm/yyyy
B. ACT Scores:
English ______ Math ______ Reading ______ Science ______ Composite ______ Test Date ___________
mm/yyyy
English ______ Math ______ Reading ______ Science ______ Composite ______ Test Date ___________
mm/yyyy
C. SAT II Test Scores (Required ONLY if Class Rank is not available or applicant is homeschooled)
Math Level 1 ______ Math Level 2 ______ English ______ Biology ______ Chemistry ______ Physics ______
U.S.History ______ World History ______
High School Checklist:
? I have enclosed an official copy of the student’s test scores and verify that the above information is correct.
? The applicant has requested that the testing agency forward a copy of his/her test scores.
NAME OF OFFICIAL (PRINT)_________________________________ TITLE _________________________________
SIGNATURE OF OFFICIAL _______________________________________ DATE ________________
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The following section must be completed by your Teamster Member Relation’s Local Union.
This application will not be processed without the attached membership verification.
LU/Lodge/Div. #: ____________________________
SECRETARY-TREASURER’S MEMBERSHIP VERIFICATION
1. I hereby certify that the above-named Teamster member Relation has not been a full-time elected officer of this Local Union,
Division, or Lodge and has been (check the appropriate box below):
? A member in “good standing” as defined in article X, section 5 of the International constitution.
? Retired from a craft represented by his or her Local Union and was a member in “continuous good standing” as defined in
Article X, Section 5 of the International constitution for 5 years prior to his/her retirement.
? A seasonal employee eligible to vote pursuant to Article XXII, Sec. 4 (c) of the Internationalconstitution.
2. I verify that the applicant is the son, daughter or financial dependent of the above-named TeamsterMember Relation.
? Yes
? No
3. Signature of Secretary-Treasurer
**BMWED members must send to the System Federation Secretary-Treasurer for signature
**BLET members must send to the National Secretary-Treasurer for signature
________________________________________________________________________________________________________
Signature Print Name Date
Applications not received by the application deadline of
March 31, 2016, will not be processed by the Scholarship Fund.
It is advised that you check in with your Local Union affiliate to make sure that they have processed your application. If time or
geographic constraints will not allow you to provide your materials to the Local Union in time, you may scan your materials and
e-mail them to: scholarship@teamster.org, or fax to (202) 624-7457.
The Scholarship Fund was established as a non-profit, stand alone, charitable incorporated organization (501(c)(3) identification #52-2206826),
which will raise significant money from affiliates and outside sources to award Teamster dependents higher scholarships than have been
possible in the past. Although children represent less than 25 percent of the population in our countries, they are 100 percent our future!
Scholarship recipients are selected on the basis of scholastic achievement, aptitude, personal qualifications and financial need by the
Scholarship Selection Committee. We consider all applicants without regard to race, religion, gender, disability or any other legally protected
status. Due to the number of applicants to this program and because the program is extremely competitive, only those students who exemplify
academic excellence should apply.


 
 
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