MYRLE M. BURK – KAPPA DELTA PI

SCIENCE EDUCATION SCHOLARSHIP

APPLICATION FORM

Spring 2011

On February 13, 2011, the thirty-second Myrle M. Burk-Kappa Delta Pi Science Education Scholarship will be awarded at a special ceremony on the UNI campus. The Myrle M. Burk – Kappa Delta Pi Science Education Scholarship is open to initiates and current members of the UNI Chapter of Kappa Delta Pi International Honor Society in Education. Applicants must be active (current dues paid by 1/24/11) members or Spring 2011 initiates. This semester’s award will be for $800. See information statement mailed to you for further details.

Personal Statement

Name ______/ Student Number ______
E-Mail ______
Campus Address ______/ Telephone ______
Permanent Address ______/ Telephone ______
Semester of Initiation to Kappa Delta Pi ______
Expected Semester of Student Teaching ______
Major: /  Elementary /  Middle School/Jr. High /  Secondary
______
concentration / ______
subject field / ______
subject
GPA in Major ______/ Overall GPA ______/ GPA in Science Courses ______
Minor ______/ Advisor ______
Other Post Secondary (Including Community Colleges) Attended ______
Names of student organizations of which you are a member ______
______
Voluntary (not for class) educational and service activities while at UNI ______
______
Honors received while at UNI ______
______
Work Experiences (including voluntary) related to education during the last four years ______
______
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MYRLE M. BURK – KAPPA DELTA PI SCIENCE EDUCATION SCHOLARSHIP

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Career Objectives:
A.Short Term ______
B.Long Term (if different) ______
Are you working to support your schooling at UNI? /  YES NO
If yes, Employer(s) ______
Current Income $ ______Summer $ ______Academic Year $ ______Total
Approximate Current Indebtedness $ ______UNI Financial Aid $ ______Other $ ______Total
Are you receiving financial aid for your tuition and/or room and board for this academic year?  YES  NO
Scholarships YES NO
2010– 2011 Loan Total $ ______Grant Total $ ______Scholarship Total $ ______

Please attach a personal statement, of approximately one typewritten, single-spaced page, in which you express your reasons for believing that you are qualified to receive the Burk – KDPScience Education Scholarship. If you are applying for more than one KDP scholarship, a distinctly different statement must be submitted for each.

Please have two letters of recommendation submitted which can help the Selection Committee assess your potential and interest in the teaching of the natural sciences. If you are applying for more than one KDP scholarship, please have distinctly different letters submitted for each.

1. / ______
Name / Address / Telephone
2. / ______
Name / Address / Telephone

I, ______, hereby make application for the Burk-Kappa Delta Pi Science Education Scholarship and authorize the Selection Committee to review my academic and financial aid records.

______

SignatureDate

Please forward your application and have your letters of recommendation sent directly to: Dr. Stephen Fortgang, KDP Faculty Counselor, 117 Schindler Education Center, University of Northern Iowa, Cedar Falls, IA 50614-0607. The absolute deadline for receipt of applications and materials is NOON on Wednesday, January 26, 2011, so those who are interested should begin the application process immediately! Candidacies of students with applications or letters received after that time will not be considered. The recipient of the Myrle M. Burk – Kappa Delta Pi Science Education Scholarship will be announced during the spring initiation program on Sunday, February 13, 2011.