MATCHING DOLLAR SCHOLARSHIP APPLICATION

This application is due on (date) – please return to: (address/email)

Please submit the following to be considered for the chapter scholarship:

  1. Completed application form
  2. A copy of your transcript and a copy of ACT/SAT scores
  3. Letters of recommendation (optional)

FAMILY EDUCATIONAL RIGHTS & PRIVACY ACT (FERPA) RELEASE

The scholarship award for which you are applying may contain funds donated to local chapters, WAA, UW-Madison, or the UW Foundation. At times, local chapters may need information regarding applicants that may include financial need, class rank, test scores, and grade point average. In order to release this information, we need your consent. If you check the “Yes” box below, you are giving your consent to release this information for the duration of your attendance at UW-Madison.

❑ Yes, I agree to release of information.

❑ No, I do not agree.

Student Signature ______Date ______

SECTION ONE: PERSONAL INFORMATION

Name:

Date of Birth:

Campus ID Number:

Permanent Address:

Campus Address:

Campus Phone:

Home Phone:

E-mail address:

Are you a first generation college student? ❑ Yes ❑ No

How will you be financing your college education?

SECTION TWO: ACADEMIC INFORMATION

Name of High School: GPA: High School Rank: out of SAT/ACT Scores:

Anticipated UW major(s):

SECTION THREE: ACTIVITIES AND INTERESTS

List and briefly describe your high school extracurricular activities (e.g. memberships in organizations, sports, etc.):

Organization Position Held / Date of Involvement / Brief description of your responsibilities

List and briefly describe volunteer activities in which you have been involved:

Organization/Activity / Date of Involvement / Brief description of how you participated

List honors or academic awards you have received (e.g., scholarly activities, research, etc.):

Award/Honor / Date / Brief description

List and briefly describe any work experience:

Position/Employer / Dates of Employment / Brief description of your work responsibilities

SECTION FOUR: SHORT ESSAY

Maximum word count: 300 words

Why did you choose the University of Wisconsin-Madison, and how do you feel it will prepare you for success?

WISCONSIN ALUMNI ASSOCIATION MATCHING DOLLAR SCHOLARSHIP APPLICATION

Please direct any questions to (name).