LSCU Credit Union Scholarship Application Course Title
Date of Program
Location of Program: Name:
Credit Union Name: Email:
Credit Union Phone (with ext.):
Credit Union Address: Present Credit Union Position: Full Time
Length of credit union service:
If you are a Volunteer, what is your full-time occupation? Credit Union Assets: $
Number of credit union employees
Brief Description of Credit Union Duties:
Offices held in Credit Union, Chapter, League, or National Association: Will you receive assistance from your Credit Union?
Will you lose wages while attending the conference?
Have you attended the conference in previous years?
Have you ever received an LSCU Foundation scholarship? If yes, specify year & course
If yes, in what amount
Briefly Explain Your Need for Financial Assistance & the Amount Requested:
Applicant Signature Please Fax to:
Date League of Southeastern Credit Unions Attention: Laura Vann Fax: 205.437.2281
Or Save Document & Email to: firstname.lastname@example.org
For LSCU Internal Use Application Approved
Recommended Approved Amount
Application reviewed by _________________________________________ Laura Vann, Vice President, Cooperative Initiatives Application Approved Patrick W. La Pine, LSCU CEO
$ Date reviewed
Approved Amount $ Date