<p> WISCONSIN ALUMNI ASSOCIATION: WAUKESHA COUNTY CHAPTER 2017 SCHOLARSHIP APPLICATION</p><p>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. </p><p>Date:</p><p>Name (First, Middle and Last):</p><p>Address: City: State: Zip:</p><p>Phone: E-mail address:</p><p>Date of birth:</p><p>High School: Cumulative GPA (on a scale of): SAT score: ACT score: Current class rank (out of how many students):</p><p>Date of application to UW-Madison: I have been accepted? Yes or Not yet </p><p>Intended field of study:</p><p>Name of guidance counselor:</p><p>Father's name: Occupation:</p><p>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</p><p>Have you completed the FAFSA financial form? Yes or No</p><p>Please describe any unusual financial situations and/or is there other information for the selection committee to consider?</p><p>List the names and ages of siblings currently in school. Name Age School Year in school 1. 2. 3. 4.</p><p>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.</p><p>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.</p><p>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</p><p>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</p><p>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</p><p>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?</p><p>Please explain your educational and career goals and why you chose your field of study.</p><p>Why do you want to attend UW-Madison?</p><p>To the best of my knowledge, all the information given in this application is complete and correct.</p><p>______(Signature of applicant) (Signature of parent or guardian)</p><p>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</p><p>Your application will not be considered if the above instructions are not followed.</p><p>This application must be postmarked by March 13, 2017 in order to qualify. </p><p>Send to: Wisconsin Alumni Association Waukesha County Chapter C/O Mary Komlo 628 Acorn Glen Delafield, Wisconsin 53018 </p><p>Please direct any questions to me at (262) 646-3760 or [email protected].</p>