| First Name: | |
| Middle Initial: | |
| Last Name: | |
| E-Mail Address | |
| Permanent/Home Address: | |
| Address 2: | |
| City: | |
| State: | |
| Zip Code: | |
| Telephone Number: | |
| Cell Phone Number: | |
| Local School Address: (Adult Learner Only) | |
| City: | |
| State: | |
| Zip Code: | |
| Telephone Number: | |
| Social Security #: | |
| Date of Birth: | |
| Gender: |
Female Male |
| Project : | |
| Date Entered Project: | |
| High School Attended | |
| Graduation Date: | |
| Address: | |
| City: | |
| State: | |
| Zip Code: | |
| College/University you attend/will attend in the fall. | |
| College City: | |
| College State: | |
| College Zip Code: | |
| Current Classification: | |
| Date you expect to graduate: | |
| GED Average: | |
| Overall College GPA (on a 4.0 scale): | |
| High School GPA (if not enrolled in college): | |
| Exam Date: | |
| College Major/Expected Major: | |
| Career Goal | |
|
PART II: TRIO PROJECT / SPONSOR INFORMATION
|
|
| Name of Director for TRIO project in which you participate(d) | |
| Phone Number of Director: | |
| Project Director Email Address: | |
| Fax Number: | |
| Sponsor's Name: | |
| Position/Title: | |
| Sponsor's Institution/Agency: | |
| City: | |
| State: | |
| Zip Code: | |
| Sponsor's Email Address: | |
| Phone Number: | |
| Name of Additional Recommendation: | |
| Address of Additional Recommendation: | |
| City: | |
| State | |
| Zipcode | |
The sponsor must complete the Sponsor Recommendation form.
The other recommender must complete the Non-Sponsor Recommendation form.
NOTE:*The individual who sponsors the applicant for the Scholarship must be a current financial member of both SAEOPP and their respective state association. Membership status of the sponsor will be verified by SAEOPP. The sponsor must complete an online Letter of Recommendation.
PART III SIGNIFICANT ACADEMIC PROGRESS
Provide a written statement that explains how significant academic improvement was made in college. The response cannot exceed the space provided.
PART IV LEADERSHIP, SCHOOL, ACTIVITIES, COMMUNITY VOLUNTEER, SERVICE, AND TRIO ACTIVITIES
List leadership roles, school activities, community volunteer or service, TRIO activities, or other activities you have participated. Your response cannot exceed the space provided.
|
Name of
Activity/Service |
Office Held
(Include Dates) |
Dates of
Activity |
PART V ESSAY
In the space below, you must submit an essay entitled,
"How My Involvement in (Name of TRIO Program) Has Assisted Me in Preparation for College Success and Success in Life"
Include a statement on "why and how this award will help you achieve your academic goals." Your essay must be typewritten, and it must be between 350-450 words. The essay cannot exceed the space provided on this page, and you must sign and date where indicated.
PART VI APPLICATION AND PROJECT CERTIFICATION
By my signature which appears below, I certify that the statements contained in this application are true and complete to the best of my knowledge. I certify that the essay submitted herein is original and is not under obligation to, or currently being reviewed for consideration by any other entity or individual. Further, I provide authorization to SAEOPP to reprint this essay in SAEOPP publications and to use in public relations activities. I, also certify that the student making application for this scholarship is a participant in the project which I direct and that he or she is otherwise eligible to compete for this award.
Full Name:
E-mail Address:
Date: