Application for Scholarship/Fellowship Awards Name of award(s) for which you are applying: Current date: Full name: Student ID: Address: Telephone: Email: Current undergraduate, graduate degree, or teacher licensure program: Degree option, if applicable (B.A., B.S., M.A., M.Ed., M.S., Ed.D.): Expected program completion date: Cumulative undergrad GPA Cumulative graduate GPA: Length of time you have been a Montana resident: Educational background, including high school, undergraduate, and graduate, as appropriate. Include name and location of schools, dates attended, and degree or diplomas earned: Complete the section below only if you are applying for a Curriculum & Instruction/Teacher Education Scholarship: Licensure level (Elementary, Secondary, or K-12): Present student status (Junior, Senior, Graduate, or Non-degree Licensure): Have you been fully admitted to the Teacher Education Program? Are you a full-time student? Do you plan to teach at the K-3 level? Page 1 of 2 Updated 01/2015 Have you been admitted to the Special Education Program? Will you enroll in student teaching Fall 2014 or Spring 2015? Do you plan to teach in Montana for 4 or more years after graduation? Are you submitting a Needs Analysis Form? From what high school did you graduate (include city and state)? What is your state of birth? In addition to this application form, please submit: • An essay (two pages maximum) in which you a) describe how you meet the criteria for all scholarships/fellowships for which you are applying and b) present your professional goals. Include specific reference to awards, accomplishments, and activities relevant to the selection criteria; • unofficial transcripts of all college and university work; • two letters of support* specific to your scholarship/fellowship request(s); o *The same two letters of support can be used for multiple scholarships. If this is the case, make sure you provide your recommender with an inclusive list of criteria to address. • a completed “Need Analysis for Scholarships” form ONLY for scholarships that list this in the selection criteria. It is not necessary to provide a separate application for more than one scholarship or fellowship. Deadline for applications is 5:00 PM on Friday, February 20, 2015 Deliver applications for scholarships/fellowships to your department’s Administrative Associate: • Health and Human Performance: Luke Alford, McGill Hall 101 • Curriculum & Instruction: Crissy Laubach-Young, PJW Education Center 229 • Educational Leadership: Administrative Office - PJW Education Center 213B • Counselor Education: Kristy Kominek, PJW Education Center 210 • Communicative Sciences and Disorders: Cyndi Starry, Curry Health Center 009 Recipients will be notified on March 13, 2015 and recipient attendance at the April 10, 2015 evening Partnership & Scholarship Recognition Gala is requested. Please save the date! Scholarship/fellowship recipients hereby agree to release all information used in evaluation for the scholarship to The University of Montana Foundation for corresponding with scholarship/fellowship donors. Signature:___________________________________ Date:_______________________ Page 2 of 2 Updated 02/2014