Application For General Education Benefits - Hawaii Electricians Training Fund
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1HAWAII ELECTRICIANS TRAINING FUND
APPLICATION FOR GENERAL EDUCATION BENEFITS
(Please print or type)
Employee _____________________________Employer _______________________Soc. Sec. No. _______________
Student _______________________________ Soc. Sec. No. ___________________ Birthdate ___________________
Student is:
[
] Self
[
] Spouse
[
] Dependent Child
Mailing Address: _____________________________________ Zip Code ___________ Day Phone # ______________
School to attend: ___________________________________________________
[
] Part-time
[
] Full-time
Classification:
[
] Freshmen
[
] Sophomore
[
] Junior
[
] Senior
[
] Graduate
General field of study/major: __________________________________________ Degree: _______________________
School year applying for: August/September 2005 to May/June 2006
Term:
[
] Semesters
[
] Trimesters
[
] Quarters
Tuition cost per term:
$ ______________
Is Student (dependent child) listed as an exemption on your Income Tax Return?
[
] Yes
[
] No
If no, please explain: ________________________________________________________________________
Does Student expect to receive any other grant(s) or scholarship(s)?
[
] Yes
[
] No
If so, how much per term? $ ______________
From whom? __________________________________________
In what form? ______________________________________
(Scholarship, grant)
TH.
DEADLINE:
THIS APPLICATION MUST BE RECEIVED AT OUR OFFICE BY JUNE 30
NO LATE APPLICATION WILL BE CONSIDERED.
NOTE: FOR RETURNING STUDENTS, A COMPLETE RECORD OF YOUR GRADES INCLUDING CURRENT SPRING
TH
SEMESTER GRADES MUST BE ON FILE AT OUR OFFICE BY JUNE 30
. (If you have previously sent in record of all
grades, then only current Spring Semester grade report is required.)
SUBMIT THIS APPLICATION BY CERTIFIED MAIL OR HAND CARRY TO:
HAWAII ELECTRICIANS TRAINING FUND
GENERAL EDUCATION COMMITTEE
1935 HAU STREET, RM 300
HONOLULU, HAWAII 96819
I understand that this application must be completely filled out, signed below, and received at the Hawaii
th
Electricians Training Fund by June 30
; and that Student’s grade report/transcript requirement as stated above,
must be met by the deadline in order for this application to be considered.
I certify that the information I have provided above is true and complete to the best of my knowledge.
______________________________________________________
__________________________
EMPLOYEE’S SIGNATURE
DATE
(REV 2/98)
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