INDIANA STATE UNIVERSITY DEPARTMENT OF CRIMINOLOGY & CRIMINAL JUSTICE JEFFREY L. SCHRINK OUTSTANDING SENIOR AWARD APPLICATION

Please print or type the following information.

Full name of applicant: SID _991-______

ISU e-mail address [email protected] Telephone number ______Name of person and local phone number of person nominating the applicant (if different from applicant):

_

Applicant's Campus Address and Phone:

Applicant's Permanent Address and Phone:

Applicant’s Parents’ Names and Home Address:

Anticipated Graduation Date: Overall g.p.a.: Major g.p.a.: ______

Attach to this application, a typewritten personal statement summarizing your personal interests and goals for the future.

Please list any co-curricular activities and dates in which you have participated while a student at ISU (including fraternities, sororities, sports, etc.) Attach an additional sheet if necessary.

Page 1 of 2 (over  ) Please list any honors or awards you have received as a student at ISU including the dates received. Attach an additional sheet if necessary.

Please list any service or volunteer work with corresponding dates you have participated in while a student at ISU. Attach an additional sheet if necessary.

Please list any other information which you believe the committee might find useful in considering your application. Attach additional sheets if necessary.

THANK YOU FOR YOUR APPLICATION.

Page 2 of 2