Return to: Susan S. RoyDEAD LINE: June 6, 2014

116 Spencer Road

Towanda, PA 18848

APPLICATION FOR THE SCHOLARSHIP AWARD

TOWANDA BRANCH-AMERICAN ASSOCIATION OF UNIVERSITY WOMEN

PLEASE COMPLETE THE FOLLOWING:

NAME: ______

ADDRESS: ______

BIRTH DATE: ______

PHONE NO.: ______EMAIL:______

______

EDUCATION:

HS ATTENDED / GRAD. YEAR / ****** / *******
COLLEGE(s) / YEARS ATTENDED / CRED TO DATE / DEGREE(s)

WHEREARE YOU CURRENTLY ENROLLED? (FULL TIME, PART TIME, NO. OF CREDITS)

______

IN WHAT PROGRAM ARE YOU ENROLLED? ______

COLLEGE ORGANIZATIONS & ACTIVITIES: ______

COLLEGE HONORS & AWARDS: ______

COMMUNITY ORGANIZATIONS TO WHICH YOU BELONG AND OFFICEHELD:

______

LIST ANY COMMUNITY AWARDS RECEIVED: ______

______

PAGE 1

BRIEFLY DESCRIBE YOUR CAREER GOALS. INCLUDE WHY YOU CHOOSE THIS FIELD AND ANY OTHER STEPS YOU HAVE TAKEN TO ACHIEVE YOUR GOALS.

______

INCLUDE WITH YOUR APPLICATION AN OFFICIAL COPY OF YOUR COLLEGE TRANSCRIPT OF GRADES.

(APPLICATIONS ARE NOT EVALUATED UNLESS ALL REQUESTED MATERIALS ARE RECEIVED BY THE DEADLINE.)

REFERENCES:

LIST THREE (3) PERSONS (NOT RELATIVES) AS REFERENCES. AT LEAST ONE REFERENCE SHOULD BE A COLLEGE INTRUCTOR OR COUNSELOR. PLEASE GIVE EACH PERSON A REFERENCE FORM (ATTACHED) TO COMPLETE AND ASK THEM TO MAIL IT TO THE PERSON INDICATED ON THE REFERENCE FORM.

  1. NAME: ______

ADDRESS: ______

PHONE NO: ______

  1. NAME: ______

ADDRESS: ______

PHONE NO: ______

  1. NAME: ______

ADDRESS: ______

PHONE: ______

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IF SELECTED, I AGREE TO THE FOLLOWING:

  • THAT IF SCHEDULE PERMITS, I WILL ATTEND THE CLUB’S JUNE BANQUET FOR PRESENTATION OF AWARD.
  • I WILL ATTEND A FUTURE TOWANDA AAUW MEETING –DATE TO BE DETERMINED- TO PROVIDE AN UPDATE TO CLUB MEMBERS.
  • THAT UPON GRADUATION I WILL RECEIVE A FREE ONE YEAR MEMBERSHIP TO TOWANDA AAUW WITH THE EXPECTATION THAT I WILL ATTEND AT LEAST 2 CLUB FUNCTIONS DURING THE 12 MONTH MEMBERSHIP PERIOD.

NOTE: YOUR SIGNATURE HERE AUTHORIZES THE VERIFICATION OF ALL REFERENCES & INFORMATION CONTAINED IN THIS APPLICATION.

“THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE”.

______

(SIGNATURE OF APPLICANT) (DATE)

PAGE 3

Return to:Susan S. RoyDEADLINE: June 6, 2014

116 Spencer Road

Towanda, PA 18848

REFERENCE

______has asked that you provide a reference for an application for the Scholarship Award of the Towanda Branch of the American Association of University Women. The more specific your answers are, the more helpful it will be to your applicant.

How long have you known the applicant? ______

In what capacity? ______

In what ways has the applicant displayed initiative? ______

______

What responsibilities have you known the applicant to undertake? ______

______

______

Have the responsibilities been fulfilled? ______

Why do you think this applicant would be a good recipient of this award? ______

______

______

______

______

______

______

Signature

The Scholarship Committee of the AAUW appreciates your prompt reply.

In accordance with the Family Education Rights and Privacy Act of 1974, you have the right to review this recommendation. The Act also provides that you may waive you right by signing the statement below.

I hereby ____waive______do not waive my right of access to this recommendation.

______

Date Signature of Applicant

Return to:Susan S. RoyDEADLINE: June 6, 2014

116 Spencer Road

Towanda, PA 18848

REFERENCE

______has asked that you provide a reference for an application for the Scholarship Award of the Towanda Branch of the American Association of University Women. The more specific your answers are, the more helpful it will be to your applicant.

How long have you known the applicant? ______

In what capacity? ______

In what ways has the applicant displayed initiative? ______

______

What responsibilities have you known the applicant to undertake? ______

______

______

Have the responsibilities been fulfilled? ______

Why do you think this applicant would be a good recipient of this award? ______

______

______

______

______

______

______

Signature

The Scholarship Committee of the AAUW appreciates your prompt reply.

In accordance with the Family Education Rights and Privacy Act of 1974, you have the right to review this recommendation. The Act also provides that you may waive you right by signing the statement below.

I hereby ____waive______do not waive my right of access to this recommendation.

______

Date Signature of Applicant

Return to:Susan S. RoyDEADLINE: June 6, 2014

116 Spencer Road

Towanda, PA 18848

REFERENCE

______has asked that you provide a reference for an application for the Scholarship Award of the Towanda Branch of the American Association of University Women. The more specific your answers are, the more helpful it will be to your applicant.

How long have you known the applicant? ______

In what capacity? ______

In what ways has the applicant displayed initiative? ______

______

What responsibilities have you known the applicant to undertake? ______

______

______

Have the responsibilities been fulfilled? ______

Why do you think this applicant would be a good recipient of this award? ______

______

______

______

______

______

______

Signature

The Scholarship Committee of the AAUW appreciates your prompt reply.

In accordance with the Family Education Rights and Privacy Act of 1974, you have the right to review this recommendation. The Act also provides that you may waive you right by signing the statement below.

I hereby ____waive______do not waive my right of access to this recommendation.

______

Date Signature of Applicant