Student's Name _____________________________________________
Address _____________________________________________
City, State, Zip _____________________________________________
Phone _____________________________________________

High School _____________________________________________
Address _____________________________________________
City, State, Zip _____________________________________________
Phone _____________________________________________

School you plan to attend _____________________________________________

Name of Parent _____________________________________________	[ ] Father [ ] Mother [ ] Stepfather [ ] Stepmother
Parent's Local # _____________________________________________
Employed by _____________________________________________

Please enter my name in the 2008 Marshall M. Hicks Memorial Scholarship Program. I understand that the program is open to students who will complete high school and enroll and attend a university, college, or trade school, etc., in 2008 and who are the son or daughter of an active or retired member of the MSUWC, or the son or daughter of an active member who died as a direct result of an on the job injury. I further understand that the awards will be determined by a blind drawing and I am in no way guaranteed to be one of the award recipients.

________________________________________________________________
Signature of Applicant Date Signature of Parent
Member of MSUWC

Click here for the Microsoft Word version of this application
Click here for scholarship rules, or click here to download the Microsoft Word version
Click here for information on past scholarship rules and winners