EMERALD EMPIRE CHAPTER

ASSOCIATION OF NORTHWEST STEELHEADERS

SCHOLARSHIP APPLICATION

Please print this form and fill in by hand. Use extra paper if necessary.

NAME:_____________________________________________________

ADDRESS:__________________________________________________

____________________________________________________________

SOCIAL SECURITY NUMBER: ________________BIRTH DATE: __________

COLLEGE/UNIVERSITY: ___________________________________________

ADDRESS: _______________________________________________________

________________________________________________________________

MAJOR: ________________________________________________________

Please check the appropriate box: [_]Undergraduate Program [_]Master's Program [_]Doctorate Program

Please list any Military Service (including Coast Guard, National Guard/Reserves): _____________

____________________________________________________________________________

Dates of Service: From______________ To______________ Discharge: _______________

Please list any Community Service Participation:

Was the above Community Service a school requirement? __________

Please attach an essay response to the following question (500 word minimum):

"What are you collegiate objectives and why?"

NAME OF SPONSORING MEMBER: _____________________________________

APPLICANTS RELATIONSHIP TO SPONSOR: _____________________________

SPONSORS SIGNATURE: _____________________________ DATE ____________

APPLICANTS SIGNATURE: ____________________________ DATE ____________

NOTE: APPLICATIONS MUST BE RECEIVED DURING THE APPLICATION PERIOD EXTENDING FROM 4/1 THROUGH 4/30.

ASSOCIATION OF NORTHWEST STEELHEADERS

EMERALD EMPIRE CHAPTER

P.O. BOX 338

EUGENE, OR  97440

EMERALD EMPIRE CHAPTER

Copyright © 2001 - 2006 [Association of Northwest Steelheaders}. All Rights reserved.

Revised:3/25/2006