Application For MCMA Single Parent Scholarship: Student Information

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Southern Illinois University Carbondale

Application for MCMA Single Parent Scholarship


Please type or print in black ink and return to your Academic Advisor. Due: January 30, 2009.

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

Work Experience and Career Goals


List any jobs, paid or volunteer, you have had in the past three years, including
part-time, student work, internships, community service, etc.
Position Years City Employer

Describe your career plans as specifically as possible:


Financial Need Supplement
Dollar amount of school paid by $
parents or other.
Family Income (approx. figure) $________________/year
Number of persons in family
Number of children in college
Employment you now have or plan to
have to help with finances

Salary per month $ /month

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:

Newspaper name and address:

________________________________________________________________

Your signature: ______________________________________________

Date: _____________________
Southern Illinois University
College of Mass Communication and Media Arts

Single Parent Scholarship

A scholarship for single parents will be awarded to a deserving students each


academic year. The qualifications are as follows:

1. Applicants must be enrolled at Southern Illinois University at


Carbondale as a graduate or undergraduate student in the College of
Mass Communication and Media Arts.
2. Students must demonstrate financial need.
3. Although all qualified MCMA students may apply, preference will be
given to Journalism majors.
4. Academic performance will also be considered in the selection
process.

Interested students should complete the Application for MCMA Single


Parent Scholarship available on the web or from your academic advisor.
Upon completion, the application should be turned in to your academic
advisor by the date indicated on the MCMA web site.

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