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Scholarship Information Form

for 2010-2011 Academic Year

Name:
First
Last
Student ID:
Address:
City:
State: Zip:  
Phone:  (Home/primary contact number)
   (Work)
   (Cell)
Email:  
Major:  
GPA:    
Class Standing:    
Projected Graduation Date:    
List community or campus clubs and organizations in which you are/have been involved. Include offices held and any awards received.
Are you working?  
If "yes," provide your place of employment, job title, rate of pay, hours worked per week and length of employment.
Do you receive any other financial aid?  
If "yes," list grants, loans or scholarships you are receiving and amounts.
Do your parents contribute financially to your education?  
If "yes," how much per semester? $
Please explain why you need/want this scholarship.  Also give any information that will strengthen your application.  
The information provided in this application is accurate and correct to the best of my knowledge.