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