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.
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