Wisconsin Alumni Association: Waukesha County Chapter

WISCONSIN ALUMNI ASSOCIATION: WAUKESHA COUNTY CHAPTER 2017 SCHOLARSHIP APPLICATION

This application is for a one-time $1,500 scholarship and valid only for UW-Madison. All applications MUST be typed. You may use as much space as needed to answer all questions.

Name (First, Middle and Last):

Address: City: State: Zip:

Phone: E-mail address:

Date of birth:

High School: Cumulative GPA (on a scale of): SAT score: ACT score: Current class rank (out of how many students):

Date of application to UW-Madison: I have been accepted? Yes or Not yet

Intended field of study:

Name of guidance counselor:

Father's name: Occupation:

Mother's name: Occupation: Have your parents filed or intend to file the forms to request financial aid from any of the schools to which you have applied? Yes or No

Have you completed the FAFSA financial form? Yes or No

Please describe any unusual financial situations and/or is there other information for the selection committee to consider?

List the names and ages of siblings currently in school. Name Age School Year in school 1. 2. 3. 4.

List, in order of preference, all applications to colleges and universities including UW-Madison. Name of college/university Application status (accepted/pending) 1. 2. 3. 4.

List all other scholarship applications. Name of scholarship (include dollar amount) Received/Pending/Declined 1. 2. 3. 4. List employment positions you have held or are now holding. Name of Company Dates employed Job title/Responsibilities 1. 2. 3. 4.

List all honors, awards or recognition you have received during high school. Honors/Awards Explanation of honor/award 1. __9__ 10__ 11__ 12 2. __9__ 10__ 11__ 12 3. __9__ 10__ 11__ 12 4. __9__ 10__ 11__ 12

List and describe your high school extracurricular activities. Include explanation of the activity, if necessary. Activity Time commitment/responsibilities 1. __9__ 10__ 11__ 12 2. __9__ 10__ 11__ 12 3. __9__ 10__ 11__ 12 4. __9__ 10__ 11__ 12

List and describe your volunteer activities. Activity Time commitment/responsibilities 1. __9__ 10__ 11__ 12 2. __9__ 10__ 11__ 12 3. __9__ 10__ 11__ 12 4. __9__ 10__ 11__ 12

Which activity has been the most rewarding for you? Why? Please indicate any additional hobbies or special talents and skills you possess. Why are these important to you?

Please explain your educational and career goals and why you chose your field of study.

Why do you want to attend UW-Madison?

To the best of my knowledge, all the information given in this application is complete and correct.

______(Signature of applicant) (Signature of parent or guardian)

Date______Date______IMPORTANT REMINDER: Please submit 5 stapled packets, each containing a copy of the following in order:  The typed and completed application  A copy of original grade transcripts (7 semesters)  2 letters of recommendation

Your application will not be considered if the above instructions are not followed.

This application must be postmarked by March 13, 2017 in order to qualify.

Send to: Wisconsin Alumni Association Waukesha County Chapter C/O Mary Komlo 628 Acorn Glen Delafield, Wisconsin 53018

Please direct any questions to me at (262) 646-3760 or [email protected].