2009-2010 Scholarship/Fellowship Application Deadline ...

Fairmount College of Liberal Arts and Sciences

1845 N Fairmount,Wichita, KS 67260-0005

316-978-6659

2009-2010 Scholarship/Fellowship Application

Fax: 316-978-3234

Deadline: February 1, 2009

Legal Name

LAST

my WSU ID

FIRST

/

Date of Birth

M.I.

/

MAIDEN OR OTHER

mm/dd/yyyy

Female

Male

Address

City

State

Zip Code

WSU Email:

Phone Number:

County

Alternate Email:

-

U.S. Citizen or National

Ethnic Status (optional):

YES

-

Alternate Phone Number:

NO

Kansas Resident

YES

-

NO

(African American, Asian, American Indian, White, non-Hispanic, etc.)

FOR OFFICE USE ONLY

Academic Major

Cumulative GPA

WSU GPA

Minor or 2nd Major

NOTE: Applicants will only be considered based on their major(s)

officially on file with the Registrar's Office.

Major GPA

Total Earned Credit Hours

FALL 2009 CLASSIFICATION (choose one):

Freshman (1-29 credit hours)

Spring 2009 Enrollment

Sophomore (30-59 credit hours)

Junior (60-89 credit hours)

Senior (90 or more credit hours)

Graduate student

High School:

HS Graduation Date:

(Month & Year)

Anticipated Fall 2009

enrollment

12 or more

credit hours

6-11

hours

1-5

hours

Anticipated Spring 2010

enrollment

12 or more

credit hours

6-11

hours

1-5

hours

NOTICE: Students who have NOT completed one full

semester at WSU must submit a copy of their most

recent transcript(s) from high school/additional

college(s) in order to verify their GPA (includes

high school and transfer students). Please have

these mailed to Candice Weathers, Scholarship

Coordinator, Fairmount College of Liberal Arts and

Sciences, Dean's Office, Lindquist Hall 200, 1845

N. Fairmount, Wichita, KS 67260-0005.

Are you currently employed?

YES

NO

Employed by

Supervisor's Name

Anticipated WSU

Graduation Date:

(Month & Year)

Hours worked

per week

(approximate) :

0-15 hours

30-40 hours

15-30 hours

40 + hours

SCHOLARSHIP STATEMENT: Please explain, in the space provided, why you chose your area of study and

how you plan to use your degree to achieve your academic, career, and personal goals.

The following LAS scholarships and fellowships have very specific criteria for consideration. Please

answer each question appropriately. (NOTE: This is not a full list of all LAS scholarships and fellowships.)

Chandler Hatfield Scholarship: If you are a science or math major, do you have any plans to teach at the secondary school level?

(If yes, please submit letters of recommendation in order to be eligible for this scholarship. At least two should be from WSU professors.)

YES

NO

Anna K. Walsh and Anna E. Walsh Scholarships: If you are an incoming freshman humanities major, did you participate in the

DSI (Distinguished Scholarship Invitational)?

YES

NO

Naomi Anderson Fellowship: Are you a member of a Greek social fraternity or sorority at WSU?

YES

NO

Brandy M. Long Scholarship: Are you an employee or dependent of an employee of the Wichita police department?

YES

NO

Darren L. Francisco Schoalrship: Are you an undergraduate student with an interest in microbiology or cell biology?

YES

NO

D. Wayne Coulson Scholarship: Do you plan to pursue an education that prepares you to practice law?

YES

NO

Fraternity or Sorority Name:

Buckley Family American Indian Scholarship: Are you an American Indian who possesses a Certificate for Degree of Indian Blood?

YES

NO

ACTIVITIES LIST: In the spaces provided, make a list of your extracurricular activities, offices held, academic

recognition, awards/honors, and community service most relevant to this scholarship application. Be sure

to include dates of participation (Ex: May 2008-August 2008). High school activity information should ONLY

be included on applications submitted by current high school students/incoming freshmen.

Extracurricular

Activities,

Offices Held

(Ex: SGA, President,

Aug. 2007-May

2008)

Academic

Recognition

Awards/Honors

Community

Service

Other Experience

(Ex: research, past

employment, other

experience relevant

to your academic

major, etc.)

ADDITIONAL STATEMENT (OPTIONAL): Please include any additional information you believe will be helpful

in determining possible scholarships. (Ex: description of your skills, attributes, special interests, goals, etc.)

FINANCIAL AID INFORMATION: (This section is optional, but MUST be completed to be considered for needbased scholarships.) Questions regarding this section may be directed to Candice Weathers, LAS

Scholarship Coordinator at 316-978-6659.

List all other financial aid and/or non-Wichita State scholarships for which you are currently applying or that you

receive. Put an asterisk (*) next to those awards that are confirmed for the 2009-2010 Academic Year (AY).

The scholarship committee will check the Free Application for Federal Student Aid (FAFSA) to verify your financial need

information. You may not be considered for need-based scholarships if you have not filled out the FAFSA (fafsa.).

All financial information will be kept confidential.

PARENT(S)/GUARDIAN(S) OF DEPENDENT STUDENTS:

STUDENT:

Adjusted gross income from your

most recent federal tax return.

Adjusted gross income from your

most recent federal tax return.

Total number of exemptions claimed on

your most recent federal tax return.

Total number of exemptions claimed on

your most recent federal tax return.

Number of dependents, claimed as

exemptions, who will be full-time college

students in the 2009-2010 AY.

Number of dependents, claimed as

exemptions, who will be full-time college

students in the 2009-2010 AY.

Estimated gross income for 2009.

Estimated gross income for 2009.

Total number of exemptions for 2009.

Total number of exemptions for 2009.

FINANCIAL STATEMENT: Please explain, in the space provided, your need for a scholarship or fellowship and how

this assistance will help you achieve your goals. (You may include information regarding your family's financial

status that you feel supports your need for scholarships/fellowships.)

Student Certification and Submission:

By submitting this application for review, I certify that all the answers I have given in this application are correct to the best of my knowledge.

I understand that failing to disclose or falsifying information could result in my dismissal from Wichita State and that making false writing is

a felony under Kansas law (K.S.A. 21-3711). Social Security number and student status data may be provided to other state agencies for use in

detection of fraudulent or illegal claims against state moneys. I grant permission to obtain information about my grade point average,

enrollment status and financial status to evaluate my candidacy for scholarship awards. I understand this information will be kept

confidential and will be available only to Scholarship Committee members having a need to know for the purpose of scholarship

Print

determination. If I am awarded a scholarship, I authorize the University to publish my name as a scholarship recipient.

Notice of Nondiscrimination: Wichita State University does not discriminate on the basis of race, religion, color, national origin, gender, age, marital status, sexual orientation, status as a

Vietnam-era veteran or disability. Any person having inquiries concerning this may contact the Office of Equal Employment Opportunity, Wichita State University, 1845 Fairmount,

Wichita, Kansas 67260-0145, (316) 978-3001.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download