Phillip Schrager Scholarship Program for Student Leaders Application

The Phillip Schrager Scholarship Program for Student Leaders at the University of Nebraska at Omaha seeks to identify high school students who have demonstrated leadership ability recognized by parents, faculty, and peers. Leadership activities in high school and/or community involving time commitment, planning, organization and management skills, together with academic achievement, will be the primary criteria for scholarship selections. Finalists will be contacted for an interview by the Selection Committee before scholarship winners are determined.

(Please use black ink to complete application)

Mr. Ms.

Address

City State ZIP

( ) ( ) Home Phone Cell Phone

NUID# (or Social Security Number if not available)

High School

Name of Parent/Guardian

Test Scores

ACT______Date Tested______SAT______Date Tested______

Cumulative grade point average for high school (use 4.0 scale)______(seven semesters)

High School Class Rank/Size______

Signed Today’s Date Applicant