David Morgan Kiekel Memorial - College of Liberal Arts
Tom & Pat Gallagher
Scholarship Application
2015-16
Application Packets MUST be received at Gilkey Hall 213 before 5:00 p.m. on
Friday, March 20, 2015
Personal Information
Name: __________________________________________________________________
(Last Name) (First Name) (Middle)
OSU ID Number: ____________________
Major: ______________________________ Minor (if any): _______________________
First Term at OSU: ______ / ______
Term Year
Total Completed Credits: _______ as of ______ / ______
Term Year
Anticipated Date of Graduation: ______ / ______ OSU GPA: ______
Term Year
Contact Information
Local Address: _________________________________________________________________
_________________________________________________________________
Local Telephone No: ____-______-______
Permanent Address: _____________________________________________________________
_____________________________________________________________
Permanent Telephone No____-______-______ Legal State of Residence: ______
High School Name and Hometown: _________________________________________________
Tom & Pat Gallagher Scholarship ($1000)
This scholarship was funded with the generous donations of Thomas L. Gallagher, Jr., and Patricia A. Gallagher. Graduates of Oregon State University, the Gallaghers believe in the value of a liberal arts education and are committed to encouraging students in pursuing liberal arts educations.
Criteria:
• Student must be enrolled as undergraduate, sophomore or higher standing, majoring in the College of Liberal Arts
• Must be in good academic standing and have a 3.25 GPA or higher
• Student must have graduated from an Oregon public high school
• Financial need will be considered in the decision process
A complete application packet includes:
1. Tom & Pat Gallagher Scholarship Application.
2. A two (2) page essay describing why you are pursuing a liberal arts education.
3. A completed financial worksheet (included).
4. ***Two (2) letters of reference and reference forms (included in this packet) from OSU faculty and/or classroom teachers who can attest to your outstanding academic performance. NOTE: No letters/references from family members, please.
☼ ☼ ☼ ☼ ☼ ☼ ☼ ☼ ☼ ☼ ☼ ☼
Incomplete applications will not be considered
All letters and forms must be received by 5:00 P.M. on
Friday, March 20, 2015. You may mail, fax, or email your documents
Tom & Pat Gallagher Scholarship Committee
OSU, College of Liberal Arts
Gilkey Hall 213
Corvallis, OR 97331
Fax: 541-737-2434
E-mail: liberalarts@oregonstate.edu
Please direct any questions to the College of Liberal Arts Student Services Office at 737-0561.
College of Liberal Arts Scholarship
Financial Worksheet
Financial Information
Will you receive OSU financial aid for the 2015-16 academic year?
Yes _____
No _____
Please list the (approximate) amount of awards you will receive for the 2015-16 academic year:
Scholarships/Grants _____
Loans _____
Please list other financial resources for the 2015-16 academic year:
Family/jobs/savings _____
Other _____
Total estimated financial resources:_____
Expected Costs for the 2015-16 academic year
Tuition/Fees _____
Room/Board _____
Transportation _____
Health Insurance _____
Travel _____
Books/Supplies _____
Clothing/Personal _____
Estimated Total Costs: _____
College of Liberal Arts Scholarship Reference Form
Page 1
Student’s Name:
The student named above has applied for the Tom & Pat Gallagher Scholarship. This scholarship was funded with the generous donations of Thomas L. Gallagher, Jr., and Patricia A. Gallagher.
Criteria:
• Student must be enrolled as undergraduate, sophomore or higher standing, majoring in the College of Liberal Arts
• Must be in good academic standing and have a 3.25 GPA or higher
• Student must have graduated from an Oregon public high school
• Financial need will be considered in the decision process
A complete reference includes this 2-page form AND a detailed letter.
Application Deadline: Friday, March 20, 2015 by 5:00PM
Note: You may submit your reference and letter via email, fax, or deliver it to the address below. Applications will not be processed unless the selection committee receives both documents.
Tom & Pat Gallagher Scholarship Committee
OSU, College of Liberal Arts
Gilkey Hall 213
Corvallis, OR 97331
Fax: 541-737-2434
E-mail: liberalarts@oregonstate.edu
College of Liberal Arts Scholarship Reference Form
Gallagher, Page 2
Student’s Name:
Please rate the applicant on the factors listed below:
| |Fair |Average |Good |Excellent |Outstanding |Not Observed |
|Interpersonal Skills | | | | | | |
|Academic Skills and Knowledge | | | | | | |
|Motivation and Perseverance | | | | | | |
|Communication Skills | | | | | | |
|Responsibility and Self-direction | | | | | | |
|Contribution to Community | | | | | | |
|Ability to Work with Groups | | | | | | |
|Attitude | | | | | | |
Your Contact information:
Print Name Date
Title/Position Institution/Business
Address and Phone
Signature
College of Liberal Arts Scholarship Reference Form
Page 1
Student’s Name:
The student named above has applied for the Tom & Pat Gallagher Scholarship. This scholarship was funded with the generous donations of Thomas L. Gallagher, Jr., and Patricia A. Gallagher.
Criteria:
• Student must be enrolled as undergraduate, sophomore or higher standing, majoring in the College of Liberal Arts
• Must be in good academic standing and have a 3.25 GPA or higher
• Student must have graduated from an Oregon public high school
• Financial need will be considered in the decision process
A complete reference includes this 2-page form AND a detailed letter.
Application Deadline: Friday, March 20, 2015 by 5:00PM
Note: You may submit your reference and letter via email, fax, or deliver it to the address below. Applications will not be processed unless the selection committee receives both documents.
Tom & Pat Gallagher Scholarship Committee
OSU, College of Liberal Arts
Gilkey Hall 213
Corvallis, OR 97331
Fax: 541-737-2434
E-mail: liberalarts@oregonstate.edu
College of Liberal Arts Scholarship Reference Form
Gallagher, Page 2
Student’s Name:
Please rate the applicant on the factors listed below:
| |Fair |Average |Good |Excellent |Outstanding |Not Observed |
|Interpersonal Skills | | | | | | |
|Academic Skills and Knowledge | | | | | | |
|Motivation and Perseverance | | | | | | |
|Communication Skills | | | | | | |
|Responsibility and Self-direction | | | | | | |
|Contribution to Community | | | | | | |
|Ability to Work with Groups | | | | | | |
|Attitude | | | | | | |
Your Contact information:
Print Name Date
Title/Position Institution/Business
Address and Phone
Signature
................
................
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