EmailMe Form - Actuarial Scholarship Application-Need Based

Name *

First Last

Email *

Phone *

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Race / National Origin

Native Language

Gender

Male

Female

Are you a veteran of the U.S. Military? *

Yes

No

Date of Birth *

MM / DD / YYYY

What is your planned major? *

High School Information

High School Name *

6 Digit High School CEEB Code *

Graduation Date *

MM / DD / YYYY

Or enter year of GED

High School Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

High School Web Site *

High School Phone *

### - ### - ####

Extracurricular, Personal and Volunteer Activities

Talents and Awards:

List each, a description, the level, and number of years of involvement.

Extracurricular Activities:

List your organizations, position, description of the activity, and hours per week of involvement.

Employment:

List the job, your title, description, hours per week, and dates of employment.

Community Service Work:

List the type of work, your role, and hours per week of involvement.

Attach additional Word, Powerpoint, PDF or text document if necessary.

Mathematics Courses

Please list all Math courses you have taken during high school and the grades you achieved in each.

*

I understand that this application is for a scholarship only for the term indicated. I agree that I am bound by the University’s regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports.

I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned.

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Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Events, activities, programs and facilities of the Univeristy are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age, Vietnam or disabled veteran status as provided by law and in accordance with the University’s respect for personal dignity.