Beta Sigma Psi

Beta Sigma Psi

National Lutheran College Fraternity

Alpha Alumni Scholarship

PO Box 17273 Urbana, IL 61803-7273

Scholarship Application

Review the Scholarship criteria in the tri-fold brochure prior to completing this form. Your responses should be TYPED on this form, or reproduced in an exact format with a word processor. You may request the form to be sent to you as a Word document by emailing the Scholarship Director at .

Applicant’s Name: ______

Home Address: ______

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E-mail Address ______

Home Phone Number: (____)______ Cell Phone Number (____)______

Have you been accepted to the University of Illinois at Urbana-Champaign? YES No

To what college unit & major? ______

Are you a JAMES SCHOLAR or a member of CAMPUS HONORS PROGRAM? YES No

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Name of High School: ______ Class Rank: of

Grade Point Average: __ on a scale of __ ACT/SAT Score: __

Please do NOT include a complete high school transcript, only fill in the items requested. You may attach a separate sheet if you so choose.

School Activities (music, sports, school clubs, etc.): ______

______School Honors and Awards: ______

______

Please list any scholarships (with amounts) you have been awarded to date: ______

Certification by High School Counselor:

I have reviewed the above facts, and certify that they are true and correct, to the best of my knowledge.

______

High School Counselor Date

Please list no more than three community activities in which you participate and briefly explain your involvement (park cleanup, Red Cross volunteer, Relay for Life, 4-H, Boy Scouts, etc.): (1)______

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(2)______

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(3)______

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Name of Home Church: ______

Address: ______

Pastor’s Name: ______Phone: (___)______

Church Activities (youth group, ushering, maintenance, choir, etc.): ______

______

______

If you could describe yourself in one word, what would it be? ______

"AND WHY?" (in 100 words or less) ______

______

______

______

______

Please attach an essay, 1 page, double spaced, on the following topic: NAME A CHALLENGE YOU FACED IN LIFE. DESCRIBE THE PROBLEM, WHAT YOU DID TO ADDRESS IT, THE OUTCOME, AND UPON REFLECTION HOW HAVE YOU GROWN THROUGH IT AS A YOUNG CHRISTIAN GENTLEMAN.
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PLEASE ALSO INCLUDE THE ATTACHED PASTORAL CERTIFICATION SHEET IN YOUR APPLICATION.
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I hereby certify that the facts stated above are true and correct.

Applicant: ______Date: ______

Parent or Guardian: ______Date: ______

This application form, an attached essay, and the certification letter must be postmarked by TUESDAY, JANUARY 31, 2012 for this application to be accepted. Scholarship finalists will be invited to interview on campus and will be contacted with more information concerning the interview at a later date.

Mail your completed application to the address shown on the first page.

Beta Sigma Psi

National Lutheran College Fraternity

Alpha Alumni Scholarship

PO Box 17273 Urbana, IL 61803-7273

PASTORAL CERTIFICATION

This Pastoral Certification is part of the application process for the Beta Sigma Psi Alumni Scholarship. This scholarship is being given by Beta Sigma Psi to assist an incoming freshman, confirmed Lutheran man attending the University of Illinois, Urbana-Champaign. Please certify that this applicant is qualified to receive this scholarship. Feel free to add any pertinent remarks regarding this applicant’s qualifications.

Return this recommendation to the applicant or the above address.

I certify that ______is a confirmed Lutheran.

Applicant’s Name

______

Date Recommending Pastor

______

Congregation Name, City, and State

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