Submit this completed form by April 14, 2017, along with the student application form. Please direct any questions to Patty Paletto at the MNYCA office via phone at 201-489-8096 or via email at patty.paletto@mnyca.org.

 * you can also download this form and mail it to MNYCA 492C Cedar Lane #535 Teaneck, NJ 07666

Download Parent/Guardian Application  (pdf)

 

 


Parent/Guardian Application

1) Your Name Date

2) Home Address City
State Zip Code

3)Phone Number

4) Employee’s Name & Address

Address City
State Zip Code

Email

5) Occupation Position

6) Relationship to Applicant

Signature of Parent/Guardian

I, agree to hereby apply for the Helene M. Senker Memorial Scholarship Award for 2017 being awarded by the Metropolitan New York Coatings Association, Inc.,

Date

Signature of Company Representative

I, agree to hereby apply for the Helene M. Senker Memorial Scholarship Award for 2017 being awarded by the Metropolitan New York Coatings Association, Inc.,

Date