Laborers’ Midwest Region Scholarship Fund Application

Applicant criteria:

A dependent (child or spouse) of a member, in good standing, of the Laborers International Union of North American (LIUNA) – Midwest Region who has died or been permanently disabled as a result of an on-the-job injury
A dependent who was chiefly dependent upon the LIUNA member
A dependent child who is under the age of 26 at the time of application
A member of LIUNA – Midwest Region who has been permanently disabled as a result of an on-the-job injury
A high school graduate or obtained a GED certification
Accepted into an accredited college, university, vocational/technical, or training school in the U.S.
Currently enrolled as a full-time student of the accredited institution and meeting the passing criteria for that institution
During enrollment, maintain a GPA that meets the passing criteria for that institution and be enrolled on a full-time status (12 or more credit hours)
Registered to vote in the state of residence

Note:

Review the form below and ensure you have all necessary materials before beginning the process. If you have any questions, contact the fund by email.
A PDF/printable version of the scholarship application is available here for applicants who prefer to mail or email their application to the Fund.

Laborers' Midwest Region Scholarship Application

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Layout

Phone (Home)

Birth Date *

Phone (Cell)

Social Security Number *

Parent/Guardian Information

Parent's Name/Legal Guardian *

Parent/Legal Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent Phone

LIUNA Member Information

Layout

Member Name *

Local Union Number *

Date of Member's Death/Disability *

Member's Social Security Number *

Education Information

High School Name/Graduation Date or GED Certification Date: *

Any Previously Attended Higher Education and Completion Date/s:

Selected for Enrollment At: *

Layout

Start Date *

Anticipated Graduation Date *

Other Scholarships You Have Been Awarded:

High School/College Achievements or Special Recognitions Received:

Supporting Documents

The following supporting documents are required:

Official school transcript from your high school, the school you are currently attending or last school attended. Official transcripts must be sent directly by the school to Laborers’ Scholarship fund. They can be sent electronically or through the mail and must have: a seal and/or official signature; be on official paper/letterhead; and have not been opened prior to being submitted. Fax or photocopies of your transcript are not acceptable
Certified copy of birth certificate
Proof of voter registration
Admission confirmation from your college/university/vocational/trade school
Detailed tuition statement which includes scholarships awarded (if applicable) and school financial services contact information
Two letters of recommendation (from teachers, professors, guidance counselor, school advisor, clergy, mentor, labor, or business leaders)
Typed statement (300 words or more) addressing the following “My goal in life is:”
Recent head shot photograph to be used on media sources if applicant is chosen as a recipient

Upload all available files here

Click or drag files to this area to upload. You can upload up to 15 files.

Note - if files must be submitted separately from this online application, please mail or email applicable materials to the address below, and ensure the applicant's name is on each piece of correspondence:

LIUNA Midwest Region Health & Safety Fund
Attention: Laborers’ Midwest Region Scholarship
1 N. Old State Capitol Plaza, Suite 525 Springfield, Illinois 62353
Email address: mrlhsf@midwestlaborers.org

Verification

Checkboxes *

By clicking this box, I/we declare that the information reported on this form, to the best of my/our knowledge, is true, correct and complete. I/We further attest that the applicant meets the application criteria. I/We understand that any false information will invalidate my application. I/We give permission for the Laborers' Midwest Region Scholarship Fund to use the applicant's photo and name in printed publications, recordings, advertising and all other communication, be it electronic or printed, without further consideration and waive all rights of ownership thereto.

Note: The Laborers’ Midwest Region Scholarship Award is made for one semester only, but is renewable each semester providing the recipient is in good academic standing and all required documents are forwarded to the Laborers’ Midwest Region Scholarship Fund. The Award may be canceled if the recipient is on academic probation. The recipient must be a full-time undergraduate student. The award does not exceed four years of funding. Each applicant must provide the Fund with his/her most recent address and email contact. Failure to provide the applicant’s address, email, or update a change of address may result in loss of an awarded scholarship.