Withers Scholar Application
Academic Year 2008-2009
NAME ___________________________________________________________DATE___________________
ADDRESS_________________________________________________________________________________
E-MAIL ________________________________________TELEPHONE NO. ( )_____________________
STUDENT ID NO. __________________________CURRENT CLASS STANDING ____________________
THIS IS A _____NEW APPLICATION_____RENEWAL
MAJOR(S) ____________________________OCCUPATIONAL OBJECTIVE _______________________
INTERESTS, ACTIVITIES, AND AWARDS___________________________________________________
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NAMES & ADDRESSES OF THREE INDIVIDUALS SUBMITTING LETTERS OF RECOMMENDATION
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PLEASE INDICATE SPRING SEMESTER & AND SUMMER SESSION ENROLLMENT.
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ON A SEPARATE SHEET OF PAPER EXPLAIN HOW YOUR CURRENT COURSE OF STUDIES RELATES TO YOUR CAREER OBJECTIVES AND DESCRIBE THE VALUE OF THIS SCHOLARSHIP TO YOU. (Please type or use word-processing.)
Return this completed application to Withers Scholars Office, c/o Department of History, CM 209, IPFW, Fort Wayne IN 46805-1499 NO LATER THAN 8 FEBRUARY.