Staff Scholarship

1. PERSONAL DATA: Please complete all lines, if not applicable mark N/A.
   
   Full Name: _____________________UID:_______________
   
   WSU Office and Location:____________________________
   
   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. List details of involvment and corresponding dates.
   
   (Note: If no activites are applicable, provide a typed explanation for the Committee Review).
   
   
4. HUMAN RESOURCES EMPLOYMENT VERIFICATION
   Original Date of Appointment: ____________
   Employee Status Verified by: ___________ Date:___________
   
   
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. I also give my permission to the Department of Human Resources to release the information requested on this form to the CSAC Scholarship Committee. Information on this page may be released to the media."
   
   Applicant Signature: _____________ __ ___ Date:_________
   
   Note: Incomplete or late applications will not be considered. 
   
   Please submit the completed application form on or before Friday, May 23, 2008:
   
   Office of Financial Aid
   Wright State University
   E136 Student Union Dayton, OH. 45435