2012-2013 KATIE SCHOOL SCHOLARSHIP APPLICATION
Deadline: Friday, December 14, 2012 –432 SFH Katie School Office
The Katie School Scholarship Selection Committee will use information from this form, as well as other relevant information, to reward students for past performance and to encourage future achievement in the study of insurance. Please attach separate sheets of paper that detail any additional information you would like to share with the Selection Committee along with a copy of your resume, the signed Katie School Ethics Pledge and the Authorization Form for Release of Student’s Judicial Record.
Please type this form neatly, accurately and completely! Inaccurate, incomplete and/or sloppy applications will not be considered.
Name______UID #
Local Address & City______Phone______
Permanent Street Address______City, State & Zip______
Email______County______
Major______ISU Cumulative GPA______
Minor______Expected Graduation Date______
Community College and CC GPA (if applicable)______
Courses Completed (Grade), In Progress (IP), or Planned (List Semester to be Taken)
FIL 250______FIL 351______FIL 354______FIL 345
FIL 350______FIL 352______FIL 355______FIL 398.1
Gamma Iota Sigma (GIS) Insurance Fraternity
Semester and Year Joined______Leadership Activities within GIS______
Katie School/Gamma Iota Sigma Events and Industry Involvement
Please check the following activities in which you have participated in the fall semester:
August 27th Meet the COB RSOs
August 29thCornBelters Game
August 30thFestival ISU
September 7thRLI Company Visit
September 11th RIMS Luncheon
September 11th Asset-Liability Management
September 12thGISFirst General Meeting
September 14th Aon & Chubb Company Visits
September 17th ALB Golf Outing
September 18th Travelers Day Luncheon
September 18th CPCU Expo & Dinner
September 18th Swiss Re Info Session & Pizza
September 19th-21st REBEX Conference
September 20th Catastrophe Modeling
September 26th Willis Info Session
September 27th Amerisure Day
September 28th Effective Networking
October 1st Telematics
October 3rd Hiscox Info Session
October 5th Katie School Alumni Golf Outing
October 11th-14th Gamma Iota Sigma Natl Conference
October 16th Katie School Insurance Executive Forum
October17th GIS General Meeting – Auto-Owners
October 18th RIMS Luncheon
October 19th Reinsurance Lunch & Learn – Gen Re
October 24thArthur J. Gallagher Info Session
October 24th – 26th Halloween Policy Fundraiser
October 29th Swiss Re Day
October 29th Executive on Campus
November 5th ARC Blood Drive
November 6th Catastrophe Insurance
November 7th GIS General Mtg – SF Women’s Network
November 8h CPCU All Industry Day
November 12th – 16thHappy Birthday Gamma Week
November 13 Volunteer at Home Sweet Home Mission
November 14thEtiquette Dinner
November 15thRIMS Luncheon
December 5th GIS Gen Mtg / Fundraiser – D.P. Dough
December 6th Bloomington Blaze Hockey Game
December 7th GIS Finals Break Social
Katie Student Leadership Certificate Program
Toastmasters
Other
Internships in Insurance or other Work Experience (please describe)______
______
Other Relevant Insurance Industry Involvement (please describe)______
______
Insurance Licensing and Professional Designations – Exam Parts Completed or Passed
Property/Casualty License______CPCU Exams Passed______
Life/Health License______CLU Exams Passed______
Series 6______SOA Exams Passed______
Series 7______CAS Exams Passed______
Volunteer WorkSince High School
List Organization, Title (if any), Date of Involvement and describe Role______
______
______
______
Other Campus Involvement and Personal Accomplishments
Use this space to include any other accomplishments of which you wish the Committee to be aware.
If you are selected as an award recipient, would your parents likely attend the Recognition Program in April?
Parents’ name(s):
Parents’ address (es):
Name of Hometown Newspaper:
Essay
Please attach a one-page, typed, single-spaced essay, on the following topic:
“What I Hope to Accomplish in the Next Five Years and What I Am Doing Now to Prepare for It.”
**Please submit your Application, Essay, Resume, signed Katie School Ethics Pledge and
Authorization Form for Release of Student’s Judicial Record **
Signature______Date______
With my signature, I certify that the information given in this application is accurate, to the best of my knowledge.