EmailMe Form - SOROPTIMIST of MIDDLETOWN MIAMI SCHOLARSHIP

PART I - PERSONAL DATA

Name *

Prefix First Middle Last Suffix

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Email *

Date of Birth *

MM / DD / YYYY

PART II - EDUCATION

a. List high school(s) and college(s) attended. *

	School Name	Dates Attended
1.
2
3.
4.

B. Discuss your educational achievements. Consider your grade point average, your course load, school committees you may have worked on, student government, etc. Only cite examples of recent accomplishments (within the last three years). *

PART III - POTENTIAL FOR ADVANCEMENT

A. Upon completing your course of study, what are your future goals? *

B. What would you consider to be your greatest contribution in time and energy to your school, home, or community in the past three years? Why? *

PART IV - FINANCIAL NEED

A. Are you currently employed? *

Yes

No

If you are currently employed, where do you work and how many hours? *

N/A if you are not currently employed

B. Discuss your financial need below. Describe any special fees, expenses, family obligations, etc. *

PART V. - FILE UPLOAD

Upload your 2 references, and transcripts.
REGARDING REFERENCE LETTERS:
One letter should be from a non-family member.
One letter must be from a Miami University professor. *

upload PDF or Word Doc files only

PART VI. - SIGNATURE

Signature *

Date *

MM / DD / YYYY

Last 4 digits of your Social Security number *