NIU OSC Dependent SCHOLARSHIP Application

NIU OPERATING STAFF
DEPENDENT SCHOLARSHIP APPLICATION

Name:

Last:

First:

Middle Initial:

NIU Student ID #

Campus Address:

Street:

City:

State

Zip:

Campus Phone:

Home Address

Street:

City

State

Zip:

Home Phone:

E-mail

Date of Birth:

Home Town Newspaper:

Name:

Address:

Graduate of:

(high school or other college/ university)

Educational Plans:

Proposed occupation or profession -

Current Year at NIU

H.S. GPA (if NIU Freshman)

College/University GPA:

Expected or declared major at NIU

Entered NIU as:

Freshman ___

Transfer ___

Graduate Student ___

Professional ___

Intended Date of College Graduation:

EXTRACURRICULAR ACTIVITIES: (activities either in high school or college)

List extracurricular, volunteer, or athletic organizations in which you participated. This would include school, community, social, church, and other organizations.

SPECIAL RECOGNITIONS OR HONORS:

This would include any leadership roles, awards, certificates, etc.

HOBBIES AND SPECIAL INTERESTS:

Musical, theatrical, travel, etc.

PROVIDE A ONE-PAGE LETTER SUMMARIZING:
academic achievement, accomplishments, goals for the future, and other interests which you think would make
you a good candidate for this Scholarship.

Parent or Guardian who works at NIU

Name Last: First: Middle Initial:

Department

Currently Employed: Yes ___ No ___ Retiree: Yes ____ No ___

Information Release:

I hereby authorize the release of any high school or university grades and other related information to the Operating Staff Scholarship Committee for the purpose of determining my qualifications for the Operating Staff Scholarship. I also authorize the use of my name and likeness in the promotion of the Operating Staff Scholarship.

Name (Signature):
Date:

Send to:
Donald Butler
OSC Dependent Scholarship Committee
Media Services
Northern Illinois University
DeKalb, Illinois 60115

Name	Last:	First:	Middle Initial:
Department
Currently Employed: Yes ___ No ___		Retiree: Yes ____ No ___