DELTA KAPPA GAMMA SOCIETY INTERNATIONAL
ALPHA PHI STATE (WEST VIRGINIA)
SCHOLARSHIP APPLICATION
Indicate award for which you are applying:
_____Gertrude Roberts Scholarship ($1,000) (Doctoral or Post-Doctoral Study)
_____State Founders Scholarship ($1,000) (Doctoral or Post-Doctoral Study)
_____ Past Presidents Scholarship ($750) (Master’s Degree Study)
_____Master’s Degree Plus Scholarship ($600.00)
PLEASE PRINT OR TYPE ALL INFORMATION ON THE APPLICATION. THE COMPLETED APPLICATION IS DUE BY FEBRUARY 1.
NAME OF APPLICANT: ______Ms., Mrs., Dr.
Delta Kappa Gama Chapter: ______
Date Initiated: ______
I. PERSONAL INFORMATION
Street Address: ______
City: ______State: ______Zip: ______
Telephone Numbers (s) ______
Fax number: ______
Email address: ______
II. EDUCATION
A. List educational institutions which you have attended.
Institution Date of Attendance Diploma or Degree granted Major
______
______
______
B. List academic honors you have received
______
______
______
III. PROFESSIONAL EXPERIENCE
A. Number of years of professional experience ______
B. List teaching, supervisory, and administrative positions you have held:
Institution City Dates Positions
______
______
______
______
IV. RECOGNITION AND ACHIEVEMENTS
A. Scholarships and/or fellowships you have received:
Scholarship Institution Duties Projects/Duties
______
______
______
B. Current Professional Organization Memberships
______
______
______
______
V. SERVICE TO DELTA KAPPA GAMMA SOCIETY INTERNATIONAL
A. List chapter and state committees on which you have served.
______
______
______
VI. EDUCATION PLANS
A. Proposed Place of Study: ______
B. Major Field: ______
C. Outline your plans and indicate how this study will benefit the field of education.
______
______
______
VIII REFERENCES
List the names of three people from whom the State Scholarship Committee will receive letters of recommendation supporting your application. Please use the recommendation form included with this application. (You will need to make 3 copies of the application.)
Name Address Position
______
______
______
VIII SIGNATURE OF APPLICANT
Print Name: ______
Signature: ______Date: ______
Mail or email your application to Scholarship Chairman.
STATE SCHOLARSHIP CHAIRMAN, Karen Zinn, 3447 Campground Rd. Tunnelton, WV 26444 or email to:
NAME OF APPLICANT ______
The above named applicant has applied for a scholarship award by The Delta Kappa Gamma Society International, Alpha Phi State, and has listed you as a reference.
In the space below or on a separate sheet, please supplement the formal application with a statement that indicates scholarly achievement, fitness for graduate study, personal qualities, character and reliability of the applicant. Please indicate how well you are acquainted with the applicant and her work.
SIGNATURE ______TITLE______
DATE: ______
PLEASE RETURN THIS FORM BY FEBRUARY 1 TO: STATE SCHOLARSHIP CHAIRMAN, Karen Zinn, 3447 Campground Rd. Tunnelton, WV 26444 or email to: