UMM United Staff Association (USA)

Scholarship Application Form

DEADLINE: Must be received by APRIL 18, 2008

Name

Address

Phone Email

Parent/Step-parent/Grandparent/Spouse/Registered Domestic Partner/Parent’s Registered Domestic Partner who is a USA employee:

Year in school (Fr., Soph., Jr., Sr., AS) Major(s)

Number of college credits completed:

The criteria for this award are listed at http://www.morris.umn.edu/USA/Scholarship.html.

Using the space below, and additional sheets if necessary, please write a brief summary of your qualifications in each of the four areas.

Scholastic Achievement (GPA):

Campus and Community Leadership:

Other Achievements:

Activities and Interests:

I certify that this information is accurate and I grant permission to the USA to gain access to my financial and scholastic records at UMM.

Signed: Date:

Submit completed application to Rita Bolluyt, Grants Development Office