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Name of Applicant:
___________________________________________________________________
Last
First
M.I. Telephone
Home Address:
___________________________________________________________________
Street
___________________________________________________________________________________
City
State
Zip Code
Date of Birth: ______________________ Sex: M ___ F ___ Soc. Sec. # _____________________
(Must be between the ages
of 13 and 16 only)
Member/Associate Member Name:
______________________________________________________
Last
First M.I.
Home Address:
___________________________________________________________________
Street
___________________________________________________________________________________
City
State
Zip Code
Member/Associate Member Employed By: _______________________OPEIU Local Union ________
Relationship to Member/Associate Member: Son ___ Daughter ___ Other ______________________
If my child is selected for this scholarship, I fully agree to adhere to the rules that have been established by the Scholarship Committee.
Signature of Parent of Applicant _____________________________________ Date: ______________
Signature of Local Union President or Secretary-Treasurer:
_______________________________ Date: ___________________ Local Union Number _________
__________________________________________
(Print name of signing officer)
The Summer Camp
is held during August of each year, at University Forest Environmental Education Center, University of Missouri, Route 2, Box 139, Williamsville, MO 63967, (573) 222-8373, Fax (573) 222-8829.
SEND APPLICATION AND INQUIRIES TO:
Office and Professional Employees International Union
Romeo Corbeil Scholarship Fund
"Summer Camp"
1660 L Street, N.W., Suite 801, Washington, D.C. 20036
Phone: (202) 393-4464 Fax: (202) 347-0649
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