SCHOOL of INFORMATION SYSTEMS & APPLIED TECHNOLOGIES (SoISAT)
College of Applied Sciences and Arts (ASA)
Southern Illinois University Carbondale
2017SoISAT GENERAL SCHOLARSHIP APPLICATION FORM
Scholarship Application Submission Requirements: Each application submitted for a scholarship evaluation MUST include this document and any additional documents required of the scholarship (please see additional requirements below). Select ONLY 1 scholarshipfrom the list below. If you are applying for more than one scholarship, you will need to fill out this application for each scholarship in which you are applying forAND provide any additional documentation that may be required. Incomplete applications will not be considered.
Type in an “X” next to the scholarship you are applying for on this application
SoISAT Scholarships (Select ONLY 1 – additional applicationsare required if applying for more than one scholarship)SoISAT Scholarships:
Camelle Logan and Sonia Phelix Scholarship (IST and TRM)
Boeing ISAT Scholarship (EST and IST) / Are you a U.S. Citizen? / Yes / No
(Must have a demonstrated interest in Security Issues)
SoISAT Program Specific Scholarships:
EST Program / IST Program / TRM Program
Elec Sys Technical Scholarship Fund / Harriet V. Ross / ATS/TRM Academic Scholarship
Electronic Management/Tech Fund / Office Systems Specialist
TYPEor clearly WRITE in your personal and program/degree information, print, Sign, and return ALL application documents to the SoISAT Main Office (ASA 106) by the Application/Submissiondue date of April 7, 2017:
1. ISAT Major (Typeor place an “X” next to the appropriate major):EST: / IST: / TRM:
2. Name:
3. SIUC DawgTag #: / 4. SIUC Email Address:
5. Mailing Address:
6. Telephone (Home): / (Mobile):
7. Number of Semester Hours Completed in Major:
8. Number of Semester Hours Currently Enrolled In:
9. SIUC Grade Point Average:
10. Year in School (Freshman, Junior, etc.):
11. Participation and positions held in student/professional organizations, community organizations, and
volunteer service (attach page if necessary):
12. Certifications held or other specific skills related to the major (attach page if necessary):
13. Financial Aid Received to date and Amounts (Type in an “X” for No or None or provide Amount(s) received in the fields provided below):
None: / No FAFSA Form on File: / Pell: / $ / MAP: / $
Direct Student Loans: / $ / ASA Scholarship / $ / Other: / $
Additional Application Requirements:
Applicants will attach a one-page professionally typewritten summary of their personal goals and objectives, as well as a statement regarding why they feel they are deserving of the scholarship.
Applicants for the Camelle Logan and Sonia Phelix Scholarship (IST and TRM), must provide a two-page professionally typewritten letter in support of their consideration and interests for this scholarship. This supersedes the one-page letter for the other scholarships identified above.
CERTIFICATION/SCHOLARSHIP WAVIER STATEMENT:
I attest that the above information is true and accurate. I understand that any information found to be untrue or inaccurate may disqualify me from consideration, and I may be required to forfeit the award. If this statement is not signed and all supportive materials (as needed) are not provided as stated above, the application will be considered incomplete and not considered for this award.
As an applicant for or recipient of a tuition wavier award from Southern Illinois University Carbondale, I understand that the University has the legal authority to release my name and address, the name of my former high school or college, the name of my award, and the award amount. This release is valid for the period of time the scholarship is in effect.
Signature: / Date:RETURN THIS SIGNED APPLICATION AND ALL SUPPORTIVE DOCUMENTS TO THE ISAT MAIN OFFICE IN ASA 106 by April 7, 2107. ONLINE STUDENTS will email their completed applications to isat.siu.edu.
SoISAT Scholarship Application 3_2017