Pre Enrollment Application

ECHOSTARS! Educational Award Scholarship

Pre Enrollment Application

Application Deadline: June 13, 2012

Minimum qualifications:

65 Educational Award Scholarship Opportunities will be awarded to incoming freshman who are selected through demonstration of volunteer and/or community service experience, HS degree with minimum GPA 3.0, agreement to complete 300 hours of service during the 2012-13 program year. The hours will include identified course time, group projects and transportation to selected service sites. Upon successfully completion of the program participants will be eligible for an educational award/scholarship in the amount of $1,175.

Personal Profile

1. Name: ______

Last First Middle

2. Are you a United States Citizen, national or lawful permanent resident alien?

YES NO

3. Social Security Number: ______

4.  Date of Birth: ______Place of Birth: ______

5.  Gender: Male Female

6.  Do you have a driver’s license? YES NO

7.  Permanent Address: ______

8.  Parent Contact Information:

Name: ______

Address: ______

Phone #: ______Email Address: ______

9.  Home Phone #: ______Cell Phone #: ______

10.  Email Address: ______

11.  Did you receive a High School Diploma or GED? YES NO

12.  High School in which you graduated? ______GPA: ______

13.  Community Service: Please describe how you have reached out to others and have been involved in your community? (Attach a separate page if needed. Include dates of involvement, organization, name and location): ______

14.  In a short paragraph, please explain why you would like to be involved in this program. (Attach a separate page if needed):

______

Please provide a COPY of your Driver’s License or State Identification Card, Social Security Card, High School Diploma, and one of the following: birth certificate, passport or proof of legal residency when you come to Preview FSU. All of these documents are required in order to participate in this program.

Signature of Participant: ______Date: ______

Applicants are not guaranteed acceptance into the program.

Formal application process will be explained upon acceptance to the program.

For more information contact Beth Bair, 301.687.4210 or .

Result of the Application will be discussed at FSU Preview. Be sure to attend the ECHOSTAR session at 5:00 PM on Day 1 in the Lane University Center.

Please submit applications by mail to:

Beth Bair

Frostburg State University

Office of Volunteerism and National Service

20 Braddock Road

Frostburg, MD 21532

Or by fax: Attention To Beth Bair: 301.687.1041.