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1 Default Question Block PUCKETT SCHOLARSHIP APPLICATION The Puckett Scholars Program was created in 1994 by Kirby and Tonya Puckett to provide scholarships for incoming freshmen from Minnesota. Any high school senior from the state of Minnesota who plans to pursue a bachelor s degree at the University of Minnesota, Twin Cities is eligible to apply for the Puckett Scholars Program. Preference is given to students of color who demonstrate strong academic achievement, leadership and/or community involvement, financial need, and who have excellent potential to succeed at the college level. The scholarship award is $4,000 for the first year, renewable annually for up to four years. In order to maintain their funding, Puckett Scholars must be registered full-time at the University of Minnesota. In addition, merit awards of $1,000 - $2,000 are given annually to scholars who maintain outstanding grade point averages. The deadline is FEBRUARY 1, All application materials (including your letter of recommendation) must be submitted electronically by this date. STUDENT INFORMATION First Name Middle Name Last Name Home Address City State Zip Code Primary

2 Secondary Cell phone Other phone Student ID# (if known; if not known, enter N/A) LETTER OF RECOMMENDATION Please send an to your recommender asking them to submit their letter of recommendation as a PDF or Word document via this link BY THE FEBRUARY 1 DEADLINE: Please list the name and contact information below for the person who will be submitting your letter of recommendation. Name of Recommender Job Title Address City State Zip Code Phone Number ESSAY Your "Essay" should be submitted as a PDF or Word document. (Please double check to make sure your file works and is not in any other format). **IMPORTANT: Save the file as follows: "YourLastName.YourFirstName.ESSAY"

3 Please compose an essay about yourself and your educational, career, and life goals. Your essay should be between words in length. Your name should appear in the upper-right hand corner of all pages. Essays must be typed. UPLOAD ESSAY BULLETED LIST OF YOUR COMMUNITY AND CULTURAL INVOLVEMENT Your "Bulleted List of Your Community and Cultural Involvement" should be submitted as a PDF or Word document. (Please double check to make sure your file works and is not in any other format). **IMPORTANT: Save the file as follows: "YourLastName.YourFirstName.LIST" This should be a list of all your participatory experiences within your community, including, but not limited to, volunteer service, positions held, organizational memberships, and cultural events and activities. Your name should appear in the upperright hand corner of all pages. Lists must be typed. UPLOAD LIST HIGH SCHOOL TRANSCRIPT Please upload a copy of your high school transcript as a scanned PDF or JPEG. (Please double check to make sure your file works and is not in any other format). **IMPORTANT: Save the file as follows: "YourLastName.YourFirstName.TRANSCRIPT"

4 It does not have to be an "official" copy. An "unofficial" copy, if that is what is available to you, will be just fine. UPLOAD TRANSCRIPT STOP! Glad you made it this far :). Now please take a minute and make sure you filled out all of the questions correctly and submitted the correct documents on the previous page. Please also remember to follow up with your recommender and make sure they submit your letter of recommendation by the February 1st deadline. NOTE: If we do not have ALL of your documents (including your letter of recommendation) by February 1st, your application will be marked "incomplete" and will not be eligible for review. Due to the high volume of applicants, we will not be able to contact each individual person who is missing application materials, and track those down. It is the student's responsibility to keep track of their application materials and when those are submitted. If you feel confident to proceed, then please click "Next" and then "Submit" on the next page. Block 1 DISCLOSURE Please read statement carefully before clicking the final "Submit" button. I hereby certify that the information provided on this application is, to the best of my knowledge, accurate and true. All required documentation is enclosed. I hereby authorize the release of information, including that contained in my Admissions application, to internal and external selection committee members as may be required to determine my eligibility for a scholarship.

5 Upon clicking the "Submit" button, you will digitally sign, date, and agree to the statement above. Powered by Qualtrics