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|W. L. “BUDDY” BILLUPS SCHOLARSHIP |

|APPLICATION FORM |

|**Interested Applicants May Apply for Scholars by December 31, 2019** |

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|Please print or type: |

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|Name:__________________________________________W#:____________________________________________ |

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|Home Mailing Address: |

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|Local Mailing Address (if different from above) |

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|Home Telephone: Cell Telephone (if different): |

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|Email Address:________________________________ High School Attended: ____________________________ |

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|Date of Graduation: Class Rank:_______________________ ACT Composite Score:____________ |

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|Major: Cumulative GPA:___________ Hours Earned at Southeastern:____________________ |

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|Directions: |

|1. Applicant should submit as one packet the following materials: |

|a. The completed W. L. “Buddy” Billups Scholarship Application Form. |

|b. A two page, typed essay describing why you want to teach in Special Education and how this scholarship will help you achieve your goal. |

|c. An unofficial copy of your Southeastern transcript. |

|The applicant stipulates that he/she is majoring in Special Education whenever possible, have an emphasis in retardation. Is a Louisiana resident. Has a Junior or Senior |

|standing with a minimum college GPA of 3.0. The applicant also agrees to the following conditions if the scholarship is awarded: |

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|Student may reapply each semester. |

|Maintains a 3.00 overall GPA. |

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|Signature:_______________________________________________________Date:__________________________________ |

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