2016 THREE RIVERS DESK AND DERRICK CLUB

SCHOLARSHIP PROGRAM APPLICATIONS MUST BE POSTMARKED NO LATER THAN APRIL 15, 2016 Students planning to pursue a four-year energy related degree from a College or University, or those enrolled in a Trade or Vocational degree program at an accredited Western Pennsylvania school, may apply to receive one (1) of three (3) available Five Hundred Dollar ($500.00) scholarships.

ELIGIBILTY REQUIREMENTS: 1. Applicant must be accepted by a College or University and attending full time (12 credit hours or more) in an energy-related program, or enrolled in a Trade or Vocational degree program of an accredited Western Pennsylvania school. (Please enclose proof of acceptance / enrollment.) 2. Applicant must submit a 500-word essay discussing: “Regulating The Energy Industry: Striking The Proper Balance”. 3. Applicant must provide a list of any internships, leadership roles, and / or service activities in which they have been involved, and provide a short description of each activity. 4. Applicant must provide a letter of recommendation in a sealed envelope from someone other than a family member or friend (e.g. Employer, Professor, Clergy, etc., qualify) 5. One scholarship will be reserved for an applicant who is either currently enrolled as a member of a Desk and Derrick Club, or otherwise recommended for the award by a current member. 6. Scholarship awards will be sent to the respective winning applicant's educational institution, and Award Certificates will be presented at a Three Rivers Desk and Derrick Club monthly meeting. 7. Application packets must be postmarked no later than April 15, 2016. (Sorry, incomplete applications cannot be considered.) 8. Scholarships will be made on a one-time, lump-sum basis. Please Return Your Application Packet To: Lawrence Edelstein Three Rivers Desk and Derrick Club c/o M.W. Gary & Associates, LLC 470 Johnson Road, Ste. 220 / Washington, PA 15301 (412) 708-4921 / [email protected]

THREE RIVERS DESK AND DERRICK CLUB 2016 Scholarship Application Last Name:

First Name:

MI: ____

Mailing Address:

______ _____

__________________________________________________________________________________________________________________ City:

State:

Zip Code:

_______ _

Email Address: Home Phone Number: Name of College, University, Trade or Vocational School Applicant is attending:

Address of School:

Applicant’s Major / Area of Study: Evidence Of College / University / Trade or Vocational School Enrollment Attached:



YES

Currently Enrolled as Desk and Derrick Member:



YES



NOT APPLICABLE

Letter of Recommendation Included in Packet:



YES

Letter of Recommendation Drafted by Desk and Derrick Member:



YES



NOT APPLICABLE

List and Briefly Describe: Internships, Leadership and/or Service Activities:

Additional Pages Attached: 

YES



NO

500-Word Essay on: “Regulating the Energy Industry: Striking the Proper Balance”



YES (ATTACHED)

Please Return this Form and the Application Packet to: Three Rivers Desk and Derrick Club c/o M.W. Gary & Associates, LLC 470 Johnson Road, Ste. 220 Washington, PA 15301 (412) 708-4921 | [email protected]

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