THE GUY AND GLORIA MUTO
 MEMORIAL SCHOLARSHIP FOUNDATION, INC.
Application Form
Must be typed for consideration

Date: _________________

Personal Data:

1. Name of Applicant: _________________________________ Date of Birth: ____/____/_______

	Work Telephone: (_____)_______________    Home Telephone: (_____)__________________

      E-mail Address: ________________________________ Fax Number  (_____)______________
 
      Home Address: ________________________________________________________________

      City: __________________________________ State: ___________ Zip Code:______________


2.    Are you employed in the Pool and Spa Industry?   ___ Yes    ___ No
                                    If Yes, go to #3. If No, go to #4.

3.    Name of company currently employed with: __________________________________________

      Company Address: ______________________________________________________________

	City: __________________________________ State: ___________ Zip Code:_______________

      Years with present company: _____________  Years in Pool/Spa Industry: __________________


4.    Name of immediate family member in the Pool/Spa Industry: _____________________________

      Is the qualifying member currently associated with a trade group? _________________________

      If yes, the name of the trade group __________________________________________________

      Has the qualifying member been an officer that group? __________________________________

      Relationship to applicant: ____________________  

      Employer of immediate family member: ______________________________________________

      Company Address: ______________________________________________________________

 	City: __________________________________ State: ___________ Zip Code:_______________

	Years with present company: _____________  Years in Pool/Spa Industry: __________________






Program Information:


5.    Level of education applying for: College ______  Post Graduate ______  Basic Education ______


6.    Name of course of study that funds are being applied for: _______________________________

	Name of proposed institution/organization providing course of study: ______________________

	Is the course of study full or part-time:  ______________________________________________     

      
7.    List any civic or volunteer organizations you are associated with and in what

	capacity: _____________________________________________________________________

	_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________


8. In your own words, why do you want to take this program or course of study and how do you think it will help you in your business or professional life?

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

	______________________________________________________________________________  

	______________________________________________________________________________

                     (attach additional sheets of paper if needed)


9. Please attach a letter of recommendation from a former or current teacher. Not applicable if
	applicant is re-entering education after five years or longer. 
    




Certification:

I certify that the information provided in this application is true and accurate. I understand that the information provided becomes property of The Guy and Gloria Muto Memorial Scholarship Foundation, Inc. and that awards are granted at the sole discretion of the Board of Directors. In the event I receive an award, I understand that my name, photo and some the information contained in this application may be used for promotional purposes.


Applicants Signature: __________________________________________ Date: _____________

If applicant is not employed in Pool/Spa Industry, the family member who is in the Pool/Spa Industry must also sign this certification.  If the applicant is employed in the Pool/Spa Industry and under 18 years old, a parent or legal guardian must sign this certification. 

Signed: ________________________________Relationship____________  Date: _____________



Association Validation:  (Must be completed for consideration)

This application has been reviewed and is forwarded to The Guy and Gloria Muto Memorial Scholarship Foundation with our validation.  To the best of our knowledge, the information contained in the application is accurate and the member is full-time in the Pool & Spa Industry and has been for at least one year. 

      Name of validating association: ____________________________________________________

      Address: ______________________________________________________________________

      City: _________________________________ State: ___________ Zip Code: _______________

      Signature of Association Officer: ____________________________________________________

      Title: ______________________________________  Telephone: (_____)___________________

      E-mail address _________________________________________________________________
The Guy and Gloria Muto Memorial Scholarship Application

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