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|Joyce Helms Memorial SCHOLARSHIP IN SPECIAL EDUCATION |

|APPLICATION FORM |

|**Interested Applicants May Apply for Scholars by September 15, 2019**  |

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|Please print or type: |

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|Name:__________________________________________W#:____________________________________________ |

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|Major: ____________ Cumulative GPA: |

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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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|High School Attended: ____________________________ Date of Graduation: |

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|Class Rank:______________________ ACT Composite Score:____________ Hours Earned at Southeastern:___________ |

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|Directions: |

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

|Joyce Helms Memorial Scholarship Form. |

|A 1-3 page typed essay describing why you want to teach students with disabilities and how this scholarship will help achieve you goal. |

|An unofficial copy of your Southeastern transcript. |

|The applicant stipulates that he/she is a full-time student majoring in Special Education 1-5 or 4-8 in the College of Education with a minimum cumulative grade point |

|average of 2.75. Junior standing is preferred but not required. The applicant also agrees to the following conditions if the scholarship is awarded: |

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|1. Applicant will maintain a minimum 2.75 cumulative grade point average and remain enrolled full-time as a College of Education major. |

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|2. The award of the scholarship for a second semester is contingent on item 1 above. |

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|Signature:_______________________________________________________Date:__________________________________ |

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