MBAA DISTRICT MID ATLANTIC
SCHOLARSHIP APPLICATION I,_________________________________________________________havereadandunderstandtheconditionsoftheMBAAMIDATLANTICDISTRICTSCHOLARSHIPasexplainedinthecurrentNotestoCandidatesforScholarships,foundhere:http://www.mbaa.com/districts/MidAtlantic/Pages/Scholarships.aspxIaffirmthatIplantopursueacareerinthebrewingindustry,orthatIamcurrentlypursuingacareerinthebrewingindustry,asdefinedintheaforementioneddocumentation.Igivepermissiontoofficialsofmycurrentandformerinstitutionstoreleasetranscriptsofmyacademicrecord,aswellasinformationfrommycurrentandformeremployer(s)andrelevantorganizations.Iunderstandthatthisapplicationwillbeavailableonlytoqualifiedpeoplewhoneedtoseeitinthecourseoftheirduties.IfselectedasanMBAAMidAtlanticScholar,IagreetoattendaMBAADistrictMidAtlanticmeeting,andwillpresentattheMBAAMidAtlanticmeeting.Iaffirmthatthiscompletedapplicationhasbeenwrittenbyme.Iaffirmtheinformationcontainedhereinistrueandaccuratetothebestofmyknowledgeandbelief.SIGNATURE:_______________________________________________________ DATE:____________________________IAMAPPLYINGFOR ☐EDUCATIONALSUPPORT ☐TRAVELSUPPORT ☐OTHER
Please give a brief explanation of why you are applying for the MBAA Mid Atlantic Scholarship. Please list intended expenditure (course, travel, educational expense, etc.).
BIOGRAPHICALQUESTIONAIRE:A.PERSONALINFORMATIONLegalNameinFull
PermanentResidence
Eligiblecandidatesmustmeeteligibilityrequirements:The recipient must be a member in good standing with the Master Brewers Association of the Americas for a period of at least twelve months and District Mid Atlantic for a period of at least twelve months prior to receiving the award. B.EMPLOYMENTCurrentEmployment
FormerEmployer(s)
LAST FIRST M.I.
STREETANDNUMBER
CITY STATE ZIPCODE
TELEPHONE EMAIL
MBAAMEMBERSHIPNUMBER MEMBERSINCE
OCCUPATION DATESTARTED UNTIL
EMPLOYERNAME
STREETANDNUMBER
CITY STATE ZIPCODE
CONTACTPERSON
CONTACTTELEPHONE CONTACTEMAIL
EMPLOYERNAME DATESOFEMPLOYMENT
EMPLOYERNAME DATESOFEMPLOYMENT
EMPLOYERNAME DATESOFEMPLOYMENT
EMPLOYERNAME DATESOFEMPLOYMENT
C.EDUCATIONEDUCATIONLEVEL ☐HIGHSCHOOL☐COMMUNITYCOLLEGE☐UNDERGRADUATE ☐MASTER☐DOCTORATE ☐_______________________
Please describe your employment in more detail. Include information about your duties and daily responsibilities.
SCHOOL DATESTARTED GRADUATION
MAJOR/THESISSUBJECT
SCHOOLCONTACTINFORMATION(ADDRESS,TELEPHONE,EMAIL)
Describeanyadditionaleducationbelow(Undergraduateeducation,Siebel,AmericanBrewersGuild,IBD,etc.)
D.EXTRACURRICULARACTIVITIES
E.AWARDSANDSCHOLARSHIPS
Listanddescribeanyrelevantextracurricularactivities.
Listanddescribeanypreviouslyreceivedscholarshipsandawards.
F.PERSONALASPIRATIONS
Doesyourcurrentemployersupportyourcurrenteducationalaspirations?☐YES☐NOIfyouansweredno,pleaseprovidedetailonhowyouplantoaccomplishyourgoalifawardedascholarship.
Pleasedescribeyourpersonalaspirations,andhowthisscholarshipwillhelpyoutofurtheryourself,thebrewingindustry,andtheMBAA.
G.REFERENCESPleaseprovideatleasttworeferences.
PleaseattachacurrentresumeorCVtothisapplicationandreturntosteve@thebrewersart.com. H.SIGNATUREIacknowledgethatthedecisionofthescholarshipcommitteeisbindingandnotavailabletoappeal.Imayonlybeawardedonescholarshippertwo-yearperiodthroughDistrictMidAtlanticandattestIhavenotreceivedoneinthelasttwoyears.Dependinguponneedtheamountofthescholarshipmaybeadjusted.AllscholarshipfundsusemustbedocumentedandsubmittedforreviewtothePresident/SecretaryofDistrictMidAtlanticpriortopaymentunlessotheragreementhasbeenreached.Allfundsmustbeusedwithintwelvemonthsofawardorwillbeforfeited.Fundsmaybetaxableandaretheresponsibilityoftherecipient.
NAME RELATIONSHIPTOAPPLICANT
MBAAMEMBER ☐YES☐NO
EMAILADDRESS TELEPHONE
NAME RELATIONSHIPTOAPPLICANT
MBAAMEMBER ☐YES☐NO
EMAILADDRESS TELEPHONE
NAME RELATIONSHIPTOAPPLICANT
MBAAMEMBER ☐YES☐NO
EMAILADDRESS TELEPHONE
NAME DATE
