*Name: (Last, First, Middle)

*E-mail Address:

*Street Address:

*City:

*State: (drop down box)       *Zip Code:

*University I.D. Number

*Local Phone Number:

*Intended Major (1):
(E.g. CCJS, ASTR, ARTT, ENGR, etc.)

*Intended Major (2):
(E.g. CCJS, ASTR, ARTT, ENGR, etc.)

*Expected Graduation Date:        

*College Grade Point Average:

*A FAFSA form is required for need-based aid. Do you have a FAFSA from on file with the University Of Maryland Office Of Financial Aid? Yes or No

WORK EXPERIENCE

Current Place of Employment:

Supervisor Name:

Hourly Rate:

Number of hours worked, per week:

During the semester:

Approximate amount earned during the semester:

Do you anticipate that your work commitment will be the same next year? Yes or No

*Please provide the following information: Research, service learning, civic engagement, study abroad and/or leadership in co-curricular activities. You may copy and paste your resume.

WORK EXPERIENCE (copy and paste resume in box)

ALSO PROVIDE NAMES, TITLES, ADDRESSES AND PHONE NUMBERS OF TWO REFERENCES. ONE SHOULD SERVE AS A PERSONAL REFERENCE AND ONE MUST BE A FACULTY MEMBER.

STUDENT STATEMENT: Please enter a statement describing Letters and Sciences advising programs and services that helped in the development of your academic plans, financial considerations affecting your ability to attend the University and other pertinent information that would be helpful in assessing your application. Please limit your statement to no more than one double-spaced pages using 12 point font. You may want to type your statement using a word processing program then copy and past into the box below.

The entire scholarship application must be submitted electronically. To submit electronically, enter your resume, references, and student statement in the boxes above.

Before you Submit, please print a copy of your application and keep for your records.

By submitting this form, I certify that the information contained in this application is correct.

Submit Application for Review