CSAC
Student Scholarship

1. Personal Data: Please complete all lines, if not applicable mark N/A.
   
   Full Name: _____________________UID:_______________
   
   Home Address:_____________________________________
   
   City/State/Zip:______________________________________
   Undergraduate   Fr   Soph   Jr   Sr   Graduate
   Cumulative Grade Point Average:_____________

   Hours Earned: _________________
   Intended Credit Hours Each Quarter:
   ____ Fall ____Winter ____ Spring ____Summer
   
   If you are a transfer student, please attach current transcripts
   
   

2. STATEMENT OF GOALS
   Please attach to this application a double-spaced typed narrative description of your intended aims including school and career goals.
   
   
3. EXTRACURRICULAR ACTIVITIES:
   Attach a typed list of Extracurricular Activities, Community Service, Offices held, and Awards or Honors received. Do Not include High School information. Only include information relevant during your Postsecondary studies. List details of involvement and corresponding dates. Include Student Name and UID on the list.
   
   (Note: If no Postsecondary activities are applicable, provide a typed explanation for the Committee Review).
   
   
4. Sponsor Information (to be completed by Human Resources):
   
   

   Name: _____________________________Relationship:_________________

   Campus Office: _________________________ Address: ________________

    

   _____________________________________ Human Resource Rep.

5. RELEASE OF INFORMATION:
   Permission must be granted for this information to be shared with the CSAC Scholarship Committee for selection of scholarship winners.

   Please sign the statement below.

   
   "I do hereby give my permission to the Office of Financial Aid to release all information I have provided on my application, my academic record, and possible information from my financial aid application to the CSAC Scholarship Committee for the purpose of consideration for scholarship assistance. Information on this page may be released to

   the media."

   Applicant Signature: _________________________ Date: _______________
   
   Note: Incomplete or late applications will not be considered.

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   Please submit the completed application form on or before Friday, May 23, 2008 to: 

6. Office of Financial Aid
   Wright State University
   E136 Student Union Dayton, OH. 45435