Irene Mercado Scholarship App. - Women's Southwest FCU

                                                    Student:  please print or type-

(c) 2004 Cal Feminist FCU

(c) 2010 Women's Southwest FCU

Full Legal Name 

of Student _____________________________________________________

Student ID # ___________________________               

What would you like us to call you? ___________________

Mailing Address______________________________________________

 City ______________________________________State___ Zip_______

 Phone_____________________Alternate Phone_________________

E-mail Address_____________________________________________

What makes you eligible to apply for this scholarship? (check boxes)

1. I am the [ ]daughter  [ ]niece  [ ]granddaughter  [ ]sister  [ ]mother  [ ]grandmother of:

    His/her name______________________________________________

    She/he is the primary owner of WS share account #__________________.  It has a 

        balance of at least $25.  She/he [ ]is  [ ]is not a member of--or related to a member of--

        WSFCU's Supervisory Committee, Board of Directors, Credit Committee, Scholarship 

        Committee, staff, or other WSFCU officers.

[ ] 2. I am a woman who is the primary owner of WSFCU share account #________________.

        It has balance of at least $25.

Please attach: (1) a detailed 12-month budget beginning with the month 

before you will start or return to school; (2) a paragraph of up to 50 

words describing how your educational program will improve your life.  

(See submission dates & instructions under Scholarship Info .)  

DO NOT include any other enclosures.

    I certify that all information provided is true and correct.  I agree that 

Women's Southwest Federal Credit Union may use my name and 

photograph (which I will provide) for publicity purposes if I am selected 

as a scholarship recipient.

 __________   _______________________________________________

Date                                        Student's Signature