SCHOLARSHIP APPLICATION

Transcription

1 NORTHEASTERN OKLAHOMA A&M COLLEGE DEVELOPMENT FOUNDATION SCHOLARSHIP APPLICATION 200 I STREET NORTHEAST MIAMI, OK NEO.EDU SUBMIT ALL OF THE FOLLOWING TO THE NEO FOUNDATION OFFICE LOCATED IN DYER HALL, ROOM 112 OR MUST BE RECEIVED IN THE MAIL/ONLINE BY 4:00 P.M. ON MARCH 1, 2018: 1. The completed and signed application form. An incomplete or illegible application will result in disqualification. 2. A one-page typed essay about your current educational goals, your degree of commitment to pursue a college education and how you anticipate making a contribution to society. NEO STUDENT ID NUMBER MALE FEMALE NEW STUDENT CONTINUING STUDENT HAVE YOU RECEIVED A FOUNDATION SCHOLARSHIP IN THE PAST YES NO FULL LEGAL NAME: LAST FIRST MIDDLE INITIAL DATE OF BIRTH (MM/DD/YY) ADDRESS SCHOOL PERSONAL SOCIAL SECURITY NUMBER PERSONAL PERMANENT ADDRESS: NUMBER & STREET APT. # CITY STATE ZIP CELL PHONE MAILING ADDRESS ALTERNATE PHONE NUMBER WORK PHONE NUMBER

2 ACADEMIC HIGH SCHOOL ATTENDED CITY/STATE DATE OF GRADUATION HIGH SCHOOL GPA ACT SCORES: LANGUAGE ARTS MATHEMATICS READING SCIENCE COMPOSITE SCORE NEO DECLARED OR EXPECTED MAJOR: EXPECTED DATE OF GRADUATION FROM NEO: 20 ENROLLMENT STATUS: PART-TIME (MINIMUM 6 HOURS) FULL-TIME (MINIMUM 12 HOURS) TRANSFERRING: FALL SPRING SUMMER ACADEMIC ACTIVITIES, HONORS, EXTRACURRICULAR ACTIVITIES: FINANCIAL HAVE YOU COMPLETED THE FREE APPLICATION FOR FEDERAL STUDENT AID (FAFSA) FORM? YES NO IF YES, WHAT IS THE STATUS: YOU ARE CONSIDERED A DEPENDENT STUDENT IF YOU ARE UNDER 24 YEARS OF AGE, UNLESS YOU ARE MARRIED OR HAVE DEPENDENTS OTHER THAN A SPOUSE, ARE AN ORPHAN/WARD OF THE COURT, OR ARE A VETERAN OF THE U.S. ARMED SERVICES. IF YOU ARE A DEPENDENT PLEASE COMPLETE SECTION 1 AND SKIP SECTION 2.

3 SECTION 1 DEPENDENT APPLICANT PARENT(S)/GUARDIAN(S) MARITAL STATUS: SINGLE MARRIED SEPARATED DIVORCED WIDOWED MOTHER S/GUARDIAN S NAME: FATHER S/GUARDIAN S NAME: MOTHER S/GUARDIAN S OCCUPATION: FATHER S/GUARDIAN S OCCUPATION: PARENT(S)/GUARDIAN(S) TOTAL COMBINED ANNUAL GROSS HOUSEHOLD INCOME: $ DO YOUR PARENT(S)/GUARDIAN(S) CONTRIBUTE TO YOUR EDUCATIONAL EXPENSES? YES NO $ DO YOU LIVE WITH YOUR PARENT(S)/GUARDIAN(S) DURING THE ACADEMIC YEAR? YES NO DO YOU PLAN ON LIVING ON CAMPUS? YES NO NUMBER OF PEOPLE YOUR PARENT(S)/GUARDIAN(S) CLAIM AS DEPENDENTS ON THEIR TAX RETURN (INCLUDE YOURSELF) HOW MANY DEPENDENTS ARE CURRENTLY IN COLLEGE (INCLUDE YOURSELF) ARE YOU RECEIVING TRIBAL FINANCIAL ASSISTANCE? YES NO TRIBE / TRIBAL NUMBER (PLEASE ATTACH A COPY OF TRIBAL CARD) WILL YOU BE RECEIVING OKLAHOMA S PROMISE? YES NO ARE EITHER PARENT/GUARDIAN A VETERAN? YES NO BRANCH OF MILITARY SECTION 2 INDEPENDENT APPLICANT ARE YOU CURRENTLY RECEIVING GOVERNMENT ASSISTANCE? YES NO ARE YOU RECEIVING SSI (SUPPLEMENTAL SECURITY INCOME)? YES NO $ WILL YOU BE RECEIVING FINANCIAL SUPPORT FROM OTHER FAMILY MEMBERS? YES NO $ ARE YOU RECEIVING TRIBAL FINANCIAL ASSISTANCE? YES NO TRIBE / TRIBAL NUMBER (PLEASE ATTACH A COPY OF TRIBAL CARD)

4 WILL YOU BE RECEIVING OKLAHOMA S PROMISE? YES NO ESTIMATE YOUR TOTAL ANNUAL GROSS HOUSEHOLD INCOME $ ARE YOU A FIRST GENERATION COLLEGE STUDENT YES NO ARE YOU A VETERAN OF THE U.S. ARMED SERVICES? YES NO IF YES, ARE YOU RECEIVING GI BENEFITS YES NO CERTIFICATION AND AUTHORIZATION: APPLICANT MUST READ AND SIGN BELOW TO BE ELIGIBLE. All of the information on this application is true and complete to the best of my knowledge. I understand that I may not receive a scholarship and that filling out this application does not guarantee that I will be selected as a recipient of a NEO A&M College Development Foundation Scholarship. Any knowingly false statements on this application may disqualify me from consideration for a scholarship. I hereby give the Scholarship Committee permission to review my academic record. I authorize the information in this application to be used in the Awards program, if I am selected as a scholarship recipient. SIGNATURE DATE THE FOLLOWING INFORMATION IS VOLUNTARY AND IS REQUESTED FOR REPORTING PURPOSES ONLY, IN ACCORDANCE WITH THE 1968 CIVIL RIGHTS ACT AS AMENDED AMERICAN INDIAN OR ALASKA NATIVE TRIBE ASIAN OR PACIFIC ISLANDER AFRICAN AMERICAN HISPANIC WHITE OTHER APPLICATION DEADLINE: MUST BE RECEIVED AND STAMPED BY THE FOUNDATION OFFICE NO LATER THAN 4:00 P.M., MARCH 1, 2017 MAIL APPLICATION TO: NEO DEVELOPMENT FOUNDATION 200 I STREET NE MIAMI, OK 74354

5 SCHOLARSHIP AWARDS GENERALLY RANGE FROM $250 TO $1,000 PER YEAR YOU MUST SELECT WHICH SCHOLARSHIPS YOU ARE APPLYING FOR All scholarships listed in this section are subject to available funds. Additionally, the amount of award is variable. PLEASE SEE COLLEGE CATALOG FOR SCHOLARSHIP CRITERIA 3M Quapaw Process Technology Scholarship Billie Pearl Able Memorial Scholarship Darlene Aldridge Pre-Engineering Scholarship Dr. Charles H. & JoAnn Angle Scholarship Arvest Business Scholarship Henry F Beechhold Memorial Endowment Shirley Routt Bomford Business Scholarship #3 BFT (British Flyers Training School) Buffalo Run Casino & Resort Scholarship Business Accounting 2000 Book Scholarship Calcagno Art Scholarship Don Caskey Memorial Scholarship Dobson Alliance Scholarship Drama & Theatre Endowed Scholarship Dan & Tim Drury Scholarship LeRoy & Pearl Dukes Memorial Scholarship Carolyn Elmore Memorial Scholarship Roger Fent Memorial Ag Scholarship Freeman Athletic Training Scholarship Charlein O. & Jim Fribley Scholarship Janice Gatewood Scholarship Robert S. Gee Memorial Scholarship Hale Family Scholarship Marge Jurgensmeyer Memorial Scholarship Family Member Virgil & Marge Jurgensmeyer Agriculture Education Scholarship Kreeger Family Scholarship Manhattan Construction Scholarship Treva McColey Scholarship Mason McWatters Memorial Scholarship Amy Mesplay Memorial Scholarship Miami & Green Country Concrete Scholarship Miami FOP Scholarship NEO Business Office/Personnel Excellence NEO Equine Scholarship NEO Women s & Friends Scholarship William E (Willie) and Jane Osborn Scholarship Physical Therapist Assistant Scholarship Tom & Judy Poole Scholarship Lance Porterfield Memorial Scholarship Benjamin Quapaw Scholarship River Bottom Sportsmen/Disabled Veterans Red Robertson Scholarship Sandy Sherard Memorial Scholarship Simpson Coed Athletic Scholarship Spinning Arrow Boys & Girls Scholarship Dr. Robert Swanson Memorial Scholarship JoAn Taylor Memorial Scholarship Homa & Lois Thomas Scholarship Kent & Kaylene Thomas Scholarship B.J. Tunnell Memorial Scholarship Umicore Process Technology Scholarship Samuel Harris Wells, Jr., Soccer Scholarship Jake L. Whitecrow Scholarship Charles Banks Wilson Art Scholarship Roy Wilson Scholarship for Agriculture Ed Woodington Memorial Scholarship Sam Wynn Memorial Scholarship Michael J Youngwirth Scholarship NEO Foundation General Scholarship *Nursing Scholarships are determined by Nursing Department and are available to second year nursing students Marcus Bunce Memorial Scholarship; Susan Graham Memorial Scholarship; McFerron Family Nursing Scholarship; Terri Miller Scholarship; Nursing Faculty Scholarship; Palmer Nursing Scholarship; Catherine Randall Nursing Scholarship; Bobbie Wood Nursing Scholarship

6 STUDENT ESSAY

7 CHECKLIST APPLICATION COMPLETED APPLICATION SIGNED ONE PAGE ESSAY COMPLETED IF APPLICABLE, COPY OF TRIBAL CARD SUBMITTED TO WHEN YOUR CHECKLIST IS COMPLETE, PLEASE CLICK THE SUBMIT BUTTON BELOW TO IT TO SANDY SHULTS.