cave return app by sa6662B

VIEWS: 0 PAGES: 4

									                                                                                                        FOR OFFICE USE ONLY
                                                                                                        ___________________
                                                                                                        ___________________
                                                                                                        ___________________


                                                 Scholarship Application
                                                   For Returning Students
                                                         2012-2013
                                               FOR Undergraduate Cave AWARD
                                                        PLEASE PRINT OR TYPE                                      Date:_____________
INSTRUCTIONS:
A. This form may be used to apply for scholarships administered by Western Kentucky University, the College Heights Foundation and the
   WKU Foundation. Beginning freshmen and community college transfers should use another form.
B. Please complete information on reverse side of the application.
C. Deadline for filing this application is March 26, 2012
D. Return completed application (both of these pages plus the Jaggers-Cave Financial Need Statement) to:
                                    Dr. Elizabeth Lemerise
                                    Dept. of Psychology
                                    Western Kentucky University
                                    1906 College Heights Blvd. #21030
                                    Bowling Green, KY 42101-1030              Social Security No:______________________________

1. Full Legal
   Name_______________________________________________________________________________________________________
                             Last                                First                                      Middle Maiden
2. Home
   Address_____________________________________________________________________________________________________
                             Street or Route                     City              State    Zip Code           County
3.   Local Address______________________________________________________ Local Phone_______________________________
4.   Were you born in Kentucky?______
5.   Birthdate:_________________________________________
6.   High School____________________________________________________ High School Graduation Date_____________________
7.   Academic Major(s) 1. _________________________________________ 2. _____________________________________________
8.   Complete the Following:

     a. Were you a full-time student at WKU? Fall Semester 2011           ( ) Yes ( ) No
                                             Spring Semester 2012         ( ) Yes ( ) No

     b. Will you be a full-time student at WKU? Fall Semester 2012          ( ) Yes ( ) No
                                                Spring Semester 2013        ( ) Yes ( ) No
                              (The Registrar’s Office will confirm your cumulative GPA and credit hours completed.)

     c. Anticipated Graduation Date: ______Year         ____May ____August ____December

     d. Race Code: ____                 1. Non-Resident Alien    4. Asian or Pacific Islander
        (This information is voluntary) 2. African American      5. Hispanic
                                        3. American Indian or    6. White
                                           Alaskan Native

9. Non-Traditional Scholarships
   Ten, $600 awards will be made to non-traditional students meeting the following requirements. Other awards may be made to non-
   traditional students.

     a. Yes____ No____ Be 25 years old or older at time the award will be used.
     b. Yes____ No____ Have completed at Western Kentucky University a minimum of one full-time semester (12 hours) or 24 credit
                       hours part-time in classes that count toward graduation, with a GPA of 3.5 or above.
     c. Yes____ No____ Have experienced a period of at least two consecutive years in which you were not enrolled in any college or
                       university.
     d. Yes____ No____ Carry a full load of undergraduate work while using the scholarship.
By signing this document, I give the representatives of the Office of Student Financial Assistance at Western Kentucky University
permission to discuss and share my academic and financial records (including, but not limited to: FAFSA information, unmet need,
tuition, charges and other billing statements, grades, GPA, EFC, and other aid received) with the representatives of the University
Scholarship Committee. You should interpret this document as conforming to the provisions of the Family Educational Rights and
Privacy Act of 1974.

Signature of Student ____________________________________________________ Date ____________
ACTIVITIES WHILE IN COLLEGE



Memberships in:                                                           Offices Held (if any):
_______________________________________________________                   __________________________________________

_______________________________________________________                   __________________________________________

_______________________________________________________                   __________________________________________

_______________________________________________________                   __________________________________________

_______________________________________________________                   __________________________________________

_______________________________________________________                   __________________________________________

Awards and Other Honors:
____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________


Extracurricular Activities (School, Community, Church, Athletic, Employment, Civic, etc.)

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

___________________________________________              _______________________________________________________

								
To top