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