8/7/2019 11 Eng-Geo Scholarship Application

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STATE OF LEGAL RESIDENCY ___________

RMCMIThe Rocky Mountain Coal Mining Institute

Arizona, Colorado, Montana, New Mexico, North Dakota, Texas, Utah and Wyoming(You must be a legal resident of one of these states)

SCHOLARSHIP APPLICATION

PERSONAL INFORMATION: (Please print legibly or type all information)

Full Name:

Cell Number: ( ) (Or the best number to reach you)

College Address (through 5/31/2011):

Street: Date of Birth: __________________________________

City/State/Zip:

Phone: ( )

Email:

Parent Names and Addresses: Mother's Name and Address (if different):

Street: Street:

City/State/Zip: City/State/Zip:

Phone: ( ) Phone: ( )

Email: Email:

____________________________________________________________________________________________

EDUCATION:

College/University:

State: Grade Point Average: Dates Attended:

Academic Contact Name: ontact Phone: ( )

____________________________________________________________________________________________

GENERAL INFORMATION:

A. On a separate sheet of paper, write an autobiography (150 words or less). Include any academic and athletic honors, extra-curricular

activities, and why you feel you deserve this scholarship.

Also include with this Scholarship Application:

B. Three references. Include name, address, business and home phone number, company or business name, and years acquainted. Atta

letters of reference or recommendation. Applications will not be considered without these reference/recommendation letters.

C. Work experience. List your work experience. For all past employment, include employers name, address, phone number, the name

of your supervisor, work performed, length of service, and the reason for leaving.

D. Answers to the following questions (limiting each to 100 words or less):

1. Why are you pursuing your present degree?

2. What do you envision doing after graduation?

I certify that the information in this application is true and complete to the best of my knowledge.

Signature: __________________________________________ Date: _________________________________

Send completed application to the address belowBEFORE the deadline of February 1, 2011.

The Rocky Mountain Coal Mining Institute3500 S. Wadsworth Blvd, Suite 211, Lakewood, CO 80235

Phone: 303/948-3300 Fax: 303/954-9004www.rmcmi.org mail@rmcmi.org

A 501(c)(3) Nonprofit Educational Association founded November 11, 1912 for members representing the coal industry

Note: You MUST be a college sophomore orjunior to apply for this RMCMI scholarship.

mailto:mail@rmcmi.orgmailto:mail@rmcmi.orgmailto:mail@rmcmi.orgmailto:mail@rmcmi.org