Feb 3, 2012 - Home Address: County: Home Phone: (______)-______-________High School Name: Scholarship Name(s) as shown ... Sec. No. Mother's full ...
Bloomsburg University of Pennsylvania
Bloomsburg University Scholarship Application, Academic Year 2012-2013 Deadline: February 3, 2012 -- 4:30 p.m. Important: Before completing this application, go to www.bloomu.edu/aid; click on BU Scholarships under Apply for Aid tab; read award criteria and application instructions! Applicant's Name:__________________________________________BU ID#:____________ College: (Please circle) Business Liberal Arts Education Science and Technology If unsure, check with your advisor. Is this a change since the Fall of 2011? yes_____no_____ Major:____________________________________________________________________________________ Is this a change since the Fall of 2011? yes_____no_____ Transfer credits accepted by Bloomsburg University:_____________ Number of Credits Earned: Grade Point Average Earned:
Expected Graduation Date:______________________ Fall 2011 ________ ________
Cumulative __________ __________
University Address:_________________________________________________________________________ University Phone: _________-_______________ Home Address:___________________________________________________ County:___________________ Home Phone: (_______)-_______-________High School Name:_____________________________________ Scholarship Name(s) as shown on award list: (You must submit a separate application to each contact person! See web instructions at www.bloomu.edu/aid (Click on BU Scholarships under Apply for Aid tab.) __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ If you are applying for the Jeanie B. ’99 & Mark Golden Scholarship, list the service man or woman’s name and their relationship to you: _____________________________________________________________________ If you are applying for the John E. Lavelle Memorial Scholarship, list the following regarding your parents: Father’s full name____________________________________________Soc. Sec. No.____________________ Mother’s full name___________________________________________Soc. Sec. No.____________________ Mother’s MAIDEN name______________________________________ If you are applying for the "Cotton" Franklin V-12 Scholarship, list the U.S. Navy Veteran's name, service number, and relationship to you: _______________________________________________________________ __________________________________________________________________________________________
Please complete the other side.
2012-2013
Bloomsburg University Scholarship Application
Page 2
If you are applying for the Veterans Memorial Scholarship, list the category which describes your eligibility status (A through G): _______________ List below the university/community activities in which you have participated by semester and describe your participation or leadership role. Spell out all organization names; do not use abbreviations. Attach all other information required by the award criteria!
Activity Name
Semester and Year You Participated
"I certify that all information contained in this application is true and correct and authorize the exchange of all information among the Financial Aid Committee, Bloomsburg University faculty/administrators, and scholarship donors which may be necessary to process my scholarship application. I understand that the awarding committee may cancel this award if I am found to be in violation of state or federal laws, civil or criminal laws, and/or the Bloomsburg University code of conduct and that I may appeal award cancellation to the University-Wide Scholarship Committee. I have attached all materials specified in the award criteria for this scholarship and agree to provide any additional documentation which may be necessary."
Signature: ____________________________________________________Date:_______________________
Bloomsburg University is committed to providing equal educational and employment opportunities to all persons without regard to race, religion, gender, age, national origin, sexual orientation, disabilities, Vietnam era veteran status or union membership. The university is additionally committed to affirmative action and will take positive steps to provide such educational and employment opportunities. Inquiries may be referred to: Director of Social Equity, Bloomsburg University, 400 E. Second St., Bloomsburg, PA 17815-1301.
