National Sorority of Phi Delta Kappa, Inc.

Gamma Upsilon Chapter Enrollment VerificationForm

Recipients of the Gamma Upsilon Chapter, National Sorority of Phi Delta Kappa, Inc. Scholarship must provide proof of full-time enrollment in an accredited college/university. Sections I and II are to be completed by the student and Section III is to be completed and mailed by the registrar’s office of the accredited college/university.

Verification forms are due to Gamma Upsilon Chapter, NSPDK, Inc., no later than Monday, October 1, 2016.

  1. Student Information

Student Name: ______

Student’s Address: ______

Student ID/ SS Number: ______

  1. Student Release of Information

I do hereby give my consent for ______to release

College/University

enrollment verification to scholarship donor, National Sorority of Phi Delta Kappa, Inc., Gamma Upsilon Chapter.

______

Signature of Scholarship RecipientDate

III Verification

(to be completed and mailed by the registrar’s office only)

I verify that the above student is enrolled full-time at ______.

College/university

______

Verified by Phone

______

TitleDate College/University

.

Mail to:

National Sorority of Phi Delta Kappa, Inc., Gamma Upsilon Chapter

Scholarship Committee

P. O. Box 154398

Waco, TX 76715-0398

National Sorority of Phi Delta Kappa, Inc

Gamma Upsilon

Scholarship Requirements

“To Foster a Spirit of Sisterhood Among Teachers and to Promote the Highest Ideals of the Teaching Profession”

  1. The applicant shall be either a male or female from the local area who plans to enter college for professional training in the field of education.
  2. Applicant must submit an essay stating (250 words) why they want to enter the field of education.
  3. The application must be postmarked by the date on the application.
  4. The applicant shall be a graduating senior with a GPA of at least 3.0 at the time the application is submitted.
  5. The applicant must submit an official transcript with the registrar’s seal of high school credit and SAT/ACT scores.
  6. The applicant must apply through the local chapter by April 15.
  7. The applicant must attend an accredited college or university
  8. The award recommendation amount will be decided upon by the local scholarship committee and accepted by chapter vote.
  9. Applicant must complete each item on the application form.
  10. Failure to adhere to the stated rules and regulations will disqualify an applicant.
  11. Candidates may secure applications from their high school counselor and/or the local scholarship committee members.
  12. Upon notification of verification of enrollment along with an official college transcript from an accredited college/university the scholarship award will be mailed to the college/university.

Local Scholarship Chair

Name: Jocelyn G. Pierce

Address:P. O. Box 154398 Waco, Texas76715

Phone:(254) 799-1139

------CUT ALONG THIS LINE------

Staple to top back of application form

VALIDATION FORM

I did receive and fully understand the rules, regulations, and eligibility requirements of this scholarship for undergraduate study in the field of Education

______

Applicant’s SignatureDate

National Sorority of Phi Delta Kappa, Inc.

Gamma Upsilon Chapter

Scholarship Application

“To Foster a Spirit of Sisterhood Among Teachers and to Promote the Highest Ideals of the Teaching Profession”

Application must be postmarked by April 15.

Please use a pen and fill in information legibly or scan information and fill in.

Please attach a Photograph

(Required)

APPLICANT INFORMATION

Applicant's Name in Full:Miss/Mr.SS#

Home Address:

City:State:Zip:

Home Phone # ( )Age:Birthdate

EDUCATION

From what high school will you graduate?When?

What college do you plan to attend?When?

What is your career goal?

What course of study (major) would you like to follow in college?

ACTIVITIES

Please list your extracurricular and community activities, excluding jobs during the past 3 years in order of their interest to you.

Year(s) of Participation and/or approx. hours per wkPositions Held

WORK EXPERIENCE

Work Experience Year(s) of Participation and/or approx. hours per wkPositions Held

YOUR FAMILY

Father's NameOccupationIncome

Address:

City:State:Zip:

Mother's NameOccupationIncome

Address:

City:State:Zip:

Guardian's NameOccupationIncome

Guardian's Address:

City:State:Zip:

How many dependent childrenHow many siblings are

under 18, including yourself, are presently enrolled in college?

supported by your parents/guardians?______

Two letters of recommendation - one of which must be a school official:

Name:Title:

Name:Title:

Today's Date:______Your signature:______