Application Form
for
AFTRA/Dan Mallinger Memorial Fund Scholarships
625 Stanwix St., Suite 2007
Pittsburgh, PA 15222
(412) 281-6767

__________________________
Name of Scholarship Applicant

Date: ___________     Date of Birth _____________     M___     F___

Name: ________________________________________

Address: ______________________________________

Address: ______________________________________

Address: ______________________________________

Phone Number: ______________________________________

Are you eligible as: AFTRA member _____ Dependant Child of member ______

Name of member as registered at AFTRA: ________________________________________

Social Security Number: _________________________ Parent Union: _________________

Dates of AFTRA Membership: From ______________ To _______________

AFTRA local: __________________________

Occupation of Parents: Father _____________ Mother _____________

Ages of: Sisters _____________ Brothers ____________

Are you applying as a: freshman____ sophomore____ junior____ senior____ post-graduate ____

In which field: academic____ performing arts____ labor relations____ broadcast journalism____

What is your career objective?__________________________________________________

List the colleges or professional schools to which you have applied in order of preference and state tuition fees for each:

_______________________________________________________________________

Indicate which, if any, have accepted you: ________________________________________

Do you intend to be a full-time student? Yes____ No____

Describe the program you intend to follow: _________________________________

For performing arts and broadcast journalism applicants only:

1. If you are currently in a school or department of performing arts or broadcast journalism, state its name and duration of your attendance:

_______________________________________________________________________

2. If you, as a performer or broadcast journalist, have had work experience and/or professional credits, please list:

_______________________________________________________________________

Have you served in the Armed Forces? ______

Are you entitled to and have you obtained any educational benefits? If so, please explain:

_______________________________________________________________________

How much scholarship aid do you require? ___________________________________

What other scholarship applications are you making? ______________________________

What scholarships have you received?

___________________________________________________________________________

State all other means by which you intend to finance your college education (loans, aid from parents and/or relatives, part-time work, savings, etc.):

________________________________________________________________________________

PLEASE NOTE:

1. A separate Advisor's Form is required from all applicants.

2. Performing arts applicants are required to submit, in addition, two letters of recommendation from professionally knowledgeable persons in the field of performing arts.

3. YOU MUST INCLUDE A TRANSCRIPT OF YOUR HIGH SCHOOL OR COLLEGE RECORDS.

4. You must also include an original essay of not less than 150 words on one of the following subjects:

a) a person, living or dead, who has had a profound influence on your life and development

b) an experience which has had a profound influence on your life and development

c) the significance to you of a higher education

5. PREFERENCE IS GIVEN TO THOSE WITH FINANCIAL NEED. YOU MUST SUBMIT APPROPRIATE EVIDENCE OF FINANCIAL NEED. (See application guidelines for details.) ALL INFORMATION WILL BE HELD STRICTLY CONFIDENTIAL.

6. IN ORDER TO SIMPLIFY PROCESSING OF YOUR APPLICATION, WE REQUIRE YOUR NAME IN THE UPPER RIGHT-HAND CORNER OF THE TAX RETURN. (There may be different names in the same family).

7. BEFORE MAY 1st, SEND APPLICATION FORM AND ALL OTHER REQUIRED INFORMATION TO: AFTRA/DAN MALLINGER MEMORIAL SCHOLARSHIPS, 625 Stanwix St., Ste. 2007, Pittsburgh, PA 15222