Application For MCMA Single Parent Scholarship: Student Information
Application For MCMA Single Parent Scholarship: Student Information
Application For MCMA Single Parent Scholarship: Student Information
Student Information
Name
Student 850 #
Permanent/Home
Address (street
address, city, state, zip)
Local Address (street
address, city, state, zip)
Permanent/Home:
Phone #
Local / cell:
Single Parent Status Initial here to verify that you are a single parent
E-mail address
Academic Record
In Fall 2009 I will be a (circle) Freshman Soph. Jr. Sr.
Credits: (0-25) (26-55) (56-85) (86+)
GPA (overall)
Major GPA
Major & Specialization (check one):
MCMA Undecided
Cinema & Photography:
Cinema
Photography
Journalism:
Advertising/IMC
News/Editorial
Photojournalism
Radio-Television:
News
Sales/Management
Audio Production
Video Production
List all post-high school academic awards and accomplishments.
Leadership Activities
List all post high school co-curricular activities. Include the number of years you
participated and the offices you held or awards you received. Please be sure to
include all activities, especially those related to your major, such as competitions,
conferences, or festivals in which you participated.
Years in
Activity Offices Held/Awards
Activity
Outline any special financial needs in detail. Please provide information about
your family responsibilities as well as the age(s) of your child(ren):
Applicant Agreement
In connection with this application, I grant members of the faculty and staff of the
College of Mass Communication and Media Arts permission to review my
personal and academic records. My waiver of legal privacy extends only to those
reviews necessary and proper in connection with the consideration of my
scholarship application. I hereby attest as the recipient of a scholarship, I
authorize an appropriate news release to the following newspaper:
________________________________________________________________
Date: _____________________
Southern Illinois University
College of Mass Communication and Media Arts