The International Code Council - iccsafe.org

1 SCHOLARSHIP APPLICATION Page 1 of 4 International code Council Scholarship Program Application Of: Application Deadline: July 31 International code Council ATTN: SCHOLARSHIPS C/O: KARLA HIGGS900 MONTCLAIR ROAD BIRMINGHAM, ALABAMA 35213 SCHOLARSHIP APPLICATION Page 2 of 4 INSTRUCTIONS TO APPLICANT 1. This application has been prepared to obtain necessary information regarding the applicant is required to give allinformation requested (unless noted as optional). Read the contents carefully and understand each question and all It is recommended that you draft your answers on an extra form prior to completing the final consideration will be given to carelessly prepared or incomplete not answer any question with a check mark.

2 If the answer is none or does not apply, it should be so stated. If spaces are inadequatefor some answers, use a separate sheet. Answers must be Include a complete financial statement (balance sheet and income statement) of responsible parties. Tax returns are indicate, by title and amount, any other financial assistance you will be following must be received by the International code Council no later than July Two recommendation forms whic h must be completed by teachers and/or faculty members or employerb. An official transcript from the last school attendedc. Copy of ACT or SAT scoresd.

3 One-page narrative from the applicant explaining why he/she should be awarded the scholarshipe. Financial Information - tax return preferredf. Application (save the completed application and then attach if sending via email) Submit all information to: Email: Mail: International code Council Attn: Scholarships c/o Karla Higgs900 Montclair Road Birmingham, AL 35213-1206 Eligibility code Enforcement EmployeesApplicants for most scholarships shall be children (as defined below) of code enforcement agency personnel. The jurisdictional authority must be an active Governmental Member of the International code Council .

4 (Please see note below.) Children (Definition)Children must be dependents as defined by the Internal Revenue Service. Typically, this includes birth children, stepchildren,legally adopted children, or a legal ward financially supported by the employee. Note: The William J. Tangye scholarship is available to children of all a ctive ICC members; however, the applicant must beenrolled in Engineering, Architecture or Construction Technology programs. Also, some of the ICC Chapters prefer candidatesfrom their home states; however, it is not a mandatory requirement. Please refer to details of all I CC Scholarship Programs onour web site at Applicants should only complete one application to apply for allscholarships for which they are Criteria The applicant must:- Be pursuing educational opportunities beyond the high school level at a recognized and/or accredited institution.

5 - Demonstrate a need for financial assistance. Financial information will be required along with detail of any other financial assistance the applicant is receiving. - Provide evidence of satisfactory scholastic achievement including grades, test scores and teacher recommendations. - Complete the Scholarship Application. A one-page narrative on why the applicant should be awarded the scholarship is also required. I solemnly affirm that all information provided is correct to the best of my knowledge and that I have read and understand the information outlined above. If I am the recipient of a scholarship I agree to use the proceeds only for the furtherance of my education at an approved institution.

6 APPLICANT S PRINTED NAME APPLICANT S SIGNATURE SCHOLARSHIP APPLICATION Page 3 of 4 Applicant s Name: (First) (Middle) (Last) Home Address: (Street) (E-Mail Address) (City) (State) (Zip) Home Phone: Date of Birth: (Optional) Applicant s Present Occupation: If employed, name of firm: Address of firm: Parent or Guardian: (Employed by Governmental Member or Active Member) Name: Home Address: (Number, Street, City, State, Zip) Email Address: _____ Name of Employer Title of position or job: Length of employment: I (applicant) hereby apply for a scholarship, which will enable me to obtain/continue my education at: (College, University, Trade School, etc.)

7 (City, State) beginning and ending (month/day/year) (month/day/year) My class standing will be (Freshman, Sophomore, Junior, Senior): My intended vocation is: . The course of study I plan to major in is: SCHOLARSHIP APPLICATION Page 4 of 4 Please list all schools attended: SCHOOL LOCATION DATES (FROM: TO :) PLEASE INDICATE THE FOLLOWING: Honors received: Professional Societies: Clubs or fraternities: Extracurricular activities: Hobbies: ADDITIONAL SCHOLARSHIPS OR FINANCIAL ASSISTANCE ADDITIONAL INFORMATION: E-Mail Address SCHOLARSHIP AWARD INFORMATION SHOULD BE SENT TO THE FOLLOWING ADDRESS: (Please Note: If information is not provided, scholarship award information will be sent to the address listed in the home address section on the previous page.)

8 Name Address: (Number, Street, City, State, Zip)