Scholarship Application

Demographic Information

Last Name (Required)

First Name (Required)

Middle Name (Required)

UW Oshkosh E-Mail Address (Required)

Local Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Home Address (Required)

City

County (Required)

State

Zip Code (Required)

Phone Number (Required)

Date of Birth (Required)

/ /

Marital Status (Required)

Family Information

Family Size (Required)

Please include mother, father, and siblings or spouse and child(ren)

1. Age of Sibling

2. Age of Sibling

3. Age of Sibling

4. Age of Sibling

5. Age of Sibling

1. Age of Child

2. Age of Child

3. Age of Child

4. Age of Child

5. Age of Child

Additional Siblings/Children

If needed, please indicate additional siblings or children, including ages, in the box below

Academic Information

High School Attended (Required)

College Major (Required)

College Minor (Required)

Credits Remaining (Required)

Please fill in the number of credits you have left to take. Only numerical answers will work.

2012-2013 Estimated Expenses

Tuition

Books

Fees

Other

Comments

Please break down the amount you in entered in "Other"

Financial Aid Award Letter

If you did not receive financial aid, please include a letter indicating the reasons why. You may scan and upload your award letter or submit a paper copy to the N/E 208 or the address below:

Curriculum and Instruction Department

UW Oshkosh

800 Algoma Blvd.

Oshoksh, WI 54902-8662

Personal Cover Letter (Required)

Please upload a letter addressing:

1) Why you feel qualified to receive a scholarship

2) Your personal and professional goals, and how a scholarship will help you attain them

3) Why you have chosen to be an educator, and how you expect to enhance Wisconsin education

4) How you have financed your education to this point and what you need financially to continue your education

5) Your activities, beyond course work, which will enhance your teaching ability

6) Your contributions to the University and/or community

The letter may be addressed to:

Scholarship Committee

Curriculum and Instruction Department

UW Oshkosh

800 Algoma Blvd

Oshkosh, WI 54901-8662

Two Letters of Recommendation (minimum)

Please list the names and contact information of those individuals who may submit letters of recommendation on your behalf below. You are required to have a minimum of two letters of recommendation; some scholarships require additional letters. Letters may be submitted electronically to candi@uwosh.edu or mailed in a sealed envelope to:

Curriculum and Instruction

UW Oshkosh

800 Algoma Blvd

Oshkosh, WI 54901-8662

1) Reference

Name (Required)

First and Last

E-mail (Required)

Telephone (Required)

Relationship (Required)

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

2) Reference

Name (Required)

First and Last

E-mail

Telephone (Required)

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

Additional Materials

If the scholarships you are applying for require additional materials, please use the fields below to add reference information or attach documents.

3) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

4) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

5) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

6) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

7) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

8) Reference

Name

First and Last

E-mail

Telephone

Relationship

(Professor, Department Chair, Supervisor, Volunteer Coordinator, etc.)

Pattie Ackerman Scholarship

Stephanie M. Honer and Martin H. Egan Memorial Scholarship

Signature (Required)

By checking this box, I certify that the information submitted is true. I understand that falsification of any information submitted by me may result in loss or forfeit of an award. I understand that all of my application materials, including letters of recommendation, must be received by the Curriculum and Instruction Department by 4:30 p.m. on Friday, January 20, 2012.

Title II Report