DOUGLASS RESIDENTIAL COLLEGE
APPLICATION FOR SCHOLARSHIPS FOR CONTINUING STUDENTS 2011-2012
PLEASE COMPLETE AND SIGN THE FORM AND RETURN BY MAY 2, 2011 TO:
Office of Research and Scholarships
Douglass Residential College
302A College Hall, 125 George Street
New Brunswick, NJ 08901-1414
In order to be considered, please SHARE your e-portfolio with
You will be notified in the summer of scholarship award decisions.
Name _________________________________ Class ___________ RUID:__ ______________
Home Address: Street:___________________________________________________________
City ___________________________________ State ___________ Zip __________________
How long have you lived in the city and state given above?______________________________
Telephone number where you can be reached____________ _____________________________
Year of high school graduation _____________
Highest Priority for Douglass Scholarships will be given to qualified students residing in Douglass
Residential College Housing.
Which of the following reflects your expected housing status for 2011-2012?
_____I have selected Douglass Residential College Housing and will be living in _________________
(name of residence hall)
______I will live in campus housing that is not DRC and will be living in_______________________
(name of residence hall)
______I will be living off-campus
______I will be commuting from my family home
Please check all that apply
______ Full-time student in 2011-20112 ____ January 2012 graduation
(12 or more credits per term) _____ Part-time Spring 2010
______ Part-time Fall 2011 ______ Project SUPER
______Plan to Study Abroad on a Rutgers University Program during the 2011-2012 academic year
In what country? _________________________________________________
____Fall 2011 _____Spring 2012______full year 2011-2012
Declared or potential major (s) _____________________________________________________
Declared or potential minor (s) _____________________________________________________
If you are a music major or minor, what is your primary instrument? _______________________
Tentative career goal _____________________________________________________________
A number of Douglass scholarships are restricted to students with a certain major or area of study,
previous school, career plans, or place of residence. Please check all that apply to you. You will be
considered for all scholarships for which you are eligible.
_____ Ann Street Elementary School in Newark, NJ
Previously Attended a Two-year (community) College:
Name of College: ________________________________________________
Received an Associate’s Degree__________Yes_______No
Graduation Date (if applicable) :____________
Names of any special scholarships received at a two-year college
Do your future plans include elementary or secondary teaching? ____Yes ____No
If Yes, what field of education?
___ special education ____ elementary education ____ secondary education, area_________
Are you involved in significant community service? Please check here __________ if we should
review your e-portfolio for recent community service outside the University.
It is helpful if you have applied for aid through the Rutgers University Financial Aid Office. Please
_____ Have submitted FAFSA for 2011
_____ Will submit FAFSA for 2012 by __________________________ (date)
Our best source of information on your financial need is the University’s Financial Aid database. If
you think their record does not give an accurate picture of your financial circumstances, please
attach a brief explanation.
Scholarships are awarded on the basis of the information you provide. If your status changes, the
amount of your award may be adjusted.
Scholarship holders must provide general information about themselves and their interests that can
be shared with donors. If you receive a scholarship award, you will be expected to complete an
acceptance/donor information form.