2021 LEHIGH VALLEY

WORKER’S MEMORIAL

CEREMONY

 

"Pray for the dead, and fight like hell for the living."

Mother Jones

 

Sunday, April 25, 2021 1 pm

50th Anniversary of the Occupational Safety & Health Act, and

30th Anniversary of the Lehigh Valley Workers’ Memorial

at the Bethlehem Rose Gardens, Bethlehem, Pa.

8TH AVENUE & UNION BOULEVARD

BETHLEHEM, PA

Light refreshments afterward

 


Lehigh Valley Workers Memorial

Scholarship Fund Application- part 1

Applicant Information

Name_____________________________

Address__________________________

_________________________________

Phone____________________________

Age _____________

Social Security # ______________________

 

Name of Person killed or injured on the job:

__________________________________

 

Your relationship to the person

__________________________________

 

Employer’s Name & Address____________________________

__________________________________

 

Date of Injury or Death_______________

 

Circumstances of Death or Injury

_____________________________­­­____

_________________________________

 

Lehigh Valley Workers Memorial

Scholarship Fund Application- part 2

School information, community involvement, references

 

Name of Educational Institution & Address

_________________________________________________________________________________________________________

 

Course of Study______________________________

 

Anticipated Graduation Date ___________

Part time or Full time student?__________

 

Anticipated cost for the next school year? ___________________________

 

List Involvement with School or Community activities, Jobs or Volunteer work. _____________________________­­

__________________________________

__________________________________

 

Names & Phone Numbers of at least 2 non-family references

1. ________________________________

__________________________________

 

2. ________________________________

__________________________________

Lehigh Valley Workers Memorial

Scholarship Fund Application- part 3

Required Essay

 

Write a brief essay about:

What the Worker’s Memorial Scholarship would mean to you.

 

Please attach your essay here

Lehigh Valley Workers Memorial

Scholarship Fund Application- part 4

 

Please Enclose All 3 Parts of

The Lehigh Valley Workers Memorial

Scholarship Fund Application and

 

MAIL TO:

Lehigh Valley Workers Memorial

Scholarship Fund

PO BOX 20226

LEHIGH VALLEY, PA 18002-0226

 

Postmarked by March 31st

 

Questions? Call  610 -266-0710