CIOhio Symposium Scholarship Application

SECTION I – Instructions

This two (2) page application is to be completed by an undergraduate student who is a resident of Ohio, majoring in Information Systems, Computer Science, or other Technology-related fields, is at least a sophomore and has at least one (1) year of study remaining, beyond the current academic year. The CIOhio Symposium Program Committee will review all applications and award one (1) $2,000 and two (2) $1,500 scholarships based on academic success, involvement in extracurricular activities, and leadership. Two (2) letters of recommendation are required.

The scholarship winners will be notified in early November and will be awarded the scholarship at the beginning of the next quarter/semester. The winners will be recognized at the CIOhio Symposium held November 21, 2008 at the Hilton Eastonin Columbus, Ohio. They will have the opportunity to attend this day-long, CIO invite-only event free of charge.

Applications must be received by October 31, 2008. Please mail your completed application to: TechColumbus,

Attn: Cindy Groeniger, Scholarship Application, 1275 Kinnear Rd., Columbus, OH 43212.

SECTION II – Contact Information

Student’s Name:

Local Address:

StreetE-mail Address

City State Zip Phone Number (specify type)

Permanent Address:

StreetAlternate Phone (specify type)

City State Zip

SECTION III – Academic Information

College/University Name:

Major:

Additional Major or Minor: Expected Graduation Date:

Overall GPA: Major GPA: Year of College (1, 2, 3, 4, 5+):

Rank (freshman, sophomore, junior, senior):

Please list any awards and/or honors that you have received:

SECTION IV – Extracurricular Activities and Leadership (use an additional sheet if necessary)

Please list any professional/academic organizations in which you have been involved (include dates of involvement and leadership positions held):

Please list any non-academic/community organizations or activities in which you have been involved

(include dates of involvement and leadership positions held):

SECTION V – Letters of Recommendation

Include two (2) letters of recommendation with your application. At least one of the letters should be from a faculty member who is familiar with your educational program. The references should comment on your character, potential for leadership, and/or your IT-related involvement/accomplishments. A confidential recommendation is not required. Each letter of recommendation must be signed by the person making the recommendation.

NOTE: If the person providing the letter wishes to write a confidential reference, he or she should place the original letter in a sealed envelope signed across the seal. Include that envelope in your application package.

SECTION VI – Certification

I certify that the information in this application is complete and accurate to the best of my knowledge.

Signature Date