0506 Application in Doc

Central Michigan University Department of Teacher Education and Professional Development SCHOLARSHIP APPLICATION FORM For 2017-2018 Awards

Handwritten applications will not be accepted. Applications must contain complete and accurate information or they will not be considered for a scholarship award. No attachments other than those required for a specific scholarship will be accepted. All applications must be received in the TEPD Office, 421 EHS Building, no later than Friday, March 17, 2017 at 5:00 pm. *Admittance to Teacher Education requires Tier 2 or Tier 3 Admission Status PERSONAL INFORMATION

Name Student ID Number: Last First Middle (or Maiden) Local Address Street City State Zip Code Permanent Address Street City State Zip Code Local/Cell Phone ( ) - Home Phone ( ) -

High School High School Graduation Date (mm/yy):

High School Location (City/State) County of Permanent Residence: / (Semester and Year) Student Teaching Abroad (if applying for the EHS International Programs Award) Please check if you had Gail Sleeper as a teacher at Gladwin Community Schools and are applying for the Gail Sleeper Memorial Endowment Please check if you are applying for the Telephone Pioneers of America Scholarship Please check if you are a First Generation College Student and are applying for the Dr. Tom & Louise Hickey Award Check if you are a Single Parent with a dependent child and applying for the Carl V. and Margaret Hahn Furney Scholarship Check if you are applying for the Susan Colby Maly Endowed Scholarship & submit a narrative on the financial impact cancer has had on you and your family’s lives with this application (1 page maximum).

ACADEMIC INFORMATION

Admission to Teacher Education (mm/yy) / Certification ELE: SED: Class Status (end of Spring 2017): Sophomore: Junior: Senior: Graduate): (or 2nd degree earner) (or Certification only)

TRANSFER CREDIT INFORMATION CMU CREDIT INFORMATION Total Credit Hours transferred to CMU Total CMU only Credit Hours (end of fall 2016) Transfer GPA (if applicable) Total CMU only Credit Hours (end of spring 2017) OVERALL GPA (CMU and transfer if applicable) (end of fall 2016) Please List Your Teaching MAJOR(S) and/or MINOR(S) MAJORS MINORS

COMPLETING YOUR APPLICATION Please review the basic requirements of each scholarship for which you are applying and make sure you are eligible. Also, please place an “X” on each line to show you have reviewed each statement as this will help you complete the application materials correctly. application is typed or word processed only requested attachments are enclosed application is submitted on 1-page/back-to-back indicated current class status all sections are completed (front & back) all 5 copies of the application are signed & dated packet contains 5 copies of the application, and 5 copies of any required attachments

Applicant's Signature Date Please list any organization(s) to which you belong or have belonged since your graduation from high school and indicate the actual year(s) (e.g.2012-2015) of involvement/membership and any offices held. (One page ONLY) Campus:

Community:

List any Honors, Awards, or Scholarships received since you graduated from high school:

Describe any experiences you have had working with children since high school graduation:

What qualities do you possess that you think should be reviewed by the Scholarship Committee:

Describe your own personal goals and beliefs about education and how they apply to your teaching: