Please check box to confirm that you are applying for a Construction Trades Training Scholarship *

CONSTRUCTION TRADES TRAINING

Date

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Name *

First Name

Last Name

Please check box to enter Biographical Information *

BIOGRAPHICAL INFORMATION

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

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Cell Phone

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Birth Date

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YYYY

Please check box to enter Family Status *

FAMILY STATUS

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Request

Start Date

MM

DD

YYYY

Finish Date

MM

DD

YYYY

By checking this box, I affirm that the information supplied in this application and accompanying documentation is complete, accurate and supplied by me and agree that LNWEF may rely on the truth and accuracy of all such information to determine, as applicable, my or my child’s eligibility for a LNWEF Scholarship. In addition, I acknowledge that the determination by LNWEF that any of such information is false or inaccurate, may alone be grounds for denial of, as applicable, my or my child’s eligibility for a past, present or future LNWEF Scholarship.

By checking this box, I give permission to LNWEF representatives to contact Arbor Management, LLC to verify that I am a resident in good standing at the home address listed on this application.

By checking this box, I acknowledge and agree that LNWEF will and may use all information contained in this Application Form or otherwise disclosed to LNWEF for the purpose of determining, as applicable, my or my child’s eligibility for a LNWEF Scholarship. In addition, I understand and agree that LNWEF will keep confidential, only the information labeled in the sections above as “confidential” and any other information I disclose to LNWEF and indicate in writing, is “confidential”. I acknowledge and agree that LNWEF and Leon N. Weiner & Associates, Inc. a Delaware Corporation ("LNWA") may use or publicly disclose (including publishing, broadcasting, posting, and otherwise releasing, communicating and divulging) any other information contained in this Application or otherwise disclosed to LNWEF, as well as the amounts (s) of the LNWEF Scholarship (s) awarded to me, the names of the institution (s) and other persons, entities or programs to whom the LNWEF Scholarship (s) awarded to me are being paid, my name, course (s) of study, degrees earned or awarded, and LNWA's websites and in other LNWEF prepared or authorized promotional materials, publications or releases, as well as to third parties such as governmental agencies, public officials, political figures, on public media (electronic, broadcasting, social, print, etc. ) and to charitable organizations, potential and actual donors and others.

By checking this box, I acknowledge that representatives of LNWEF may require, and I agree to disclose to such representatives, additional information they may, from time to time, request from me in order to fully consider my Application and that my failure to comply with any such requests may alone be grounds for denial of, as applicable , my or my child’s eligibility for a LNWEF Scholarship.

By checking this box, I acknowledge that I have read and understood the Application Affirmations.

Signature Date

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DD

YYYY