SCHOLARSHIP APPLICATION

Please complete this form. Typed or printed forms are acceptable.

APPLICANT INFORMATION
Last
First Name MI
Name
Home
Apt/Suite
Address
City State Zip Code
Email Phone
Address Number

EDUCATION INFORMATION
[ ]
Type of [ ] 2-Year
[ ] 4-Year College Graduate [ ] Other
School College
School
Institution
Address
Name
Admissions
City, State
Office Phone
Major or Grad
GPA
Field of Study Date

ACTIVITIES & AWARDS

Honors &
Awards
Extracurricular
Activities

Jobs

Volunteer
Work
Terms & Conditions
By applying for the Creative Safety Supply scholarship, you agree to these terms:

• You must be a citizen of the United States to be considered for the scholarship.
• Awards will be sent directly to the educational institution the student attends.
• Applicants must be currently enrolled in the accredited educational institution of their choice for
the upcoming semester.
• Applicants must be full-time students (i.e. they must be enrolled in enough courses to be
considered full time by their educational institution).
• Creative Safety Supply may use any work submitted by scholarship winners as part of the
competition for any purpose deemed necessary by the company.
• Winners may be required to submit a current photo and publicity release granting Creative Safety
Supply permission to use their photo for marketing purposes and on creativesafetysupply.com.
• Scholarship winners will be notified using the contact information provided in their applications. If
we are unable to reach the winner within 30 days, he/she will forfeit the scholarship and Creative
Safety Supply reserves the right to select a new winner.
• The scholarship is not renewable; winners may not reapply.
• Creative Safety Supply reserves the right to change the scholarship program at any time,
including deadlines, requirements, scholarship amount, and other parts of the program. We also
reserve the right to cancel the program for any reason.

I have read and understand the conditions of the Creative Safety Supply scholarship
and affirm that the contents of this application are my own work. I affirm the information
contained herein is true and accurate to the best of my knowledge.

Full Name Date

All application materials must be received by the fall and winter deadlines (July
15th and December 15th) in order to be considered.
Send your completed application form, along with your essay responses and a
copy of your transcripts, to scholarships@creativesafetysupply.com.

About Creative Safety Supply

Creative Safety Supply is a retailer of safety and lean manufacturing products for the
workplace. The Beaverton, Oregon-based company helps businesses comply with floor
marking, labeling, and safety requirements and create spaces that are easy to navigate.
The company’s products help safety and facility managers take control of marking their
workplaces with products that are simple to use and last a long time. Creative Safety
Supply believes everyone plays an important role in safety and seeks to help people
find creative solutions for their workplace safety problems.