WYOMING LIFELONG LEARNING ASSOCIATION
PAUL KIPPER SCHOLARSHIP APPLICATION
Application Deadline: August 15, 2008
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Applicant_______________________________________________________________________________ |
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Home Address___________________________________________________________________________ |
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City/State/Zip____________________________________________________________________________ |
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Social Security Number_____________________________________________________________________ |
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Home Telephone__________________________________________________________________________ |
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Academic year for which you are applying_______________________________________________________ |
EDUCATION INFORMATION
| _______________________________________________________________________________________ Name and address of college or university you plan to attend |
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Officially admitted to graduate school? Yes__________ No___________When?__________ |
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Credit hours complete at the end of current semester_______________________________________________ |
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Your graduate major_______________________________________________________________________ |
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Expected date of graduation_________________________________________________________________ |
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Earned degrees: |
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| Title | Major | Date | Institution |
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_______________________________________________________________________________________ |
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_______________________________________________________________________________________ |
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_______________________________________________________________________________________ |
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Attach a brief summary outlining your educational goals and career aspirations. Indicate how this award will assist you in achieving your educational goals. (Do not exceed two typewritten pages, double-spaced.)
FINANCIAL INFORMATION
| Married_____________________________________ | Single_______________________________________ |
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Dependents (No.)__________Attending school (Y/N)__________College(Y/N)__________ |
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Family income (married or singles): $10-15,000____________$15-20,000____________$20-25,000____________Above $25,000____________ |
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Applicant's expected income during the year $_____________________________________ |
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Applicant's expenses (school related) |
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| Tuition & Fees | $____________________ |
| Books & Supplies | $____________________ |
| Travel | $____________________ |
| Room & Board | $____________________ |
| Total Expenses | $____________________ |
APPLICANT'S STATEMENT
If I am granted this scholarship from the Wyoming Lifelong Learning Association, I understand and affirm the following:
I must be enrolled in graduate course work to receive this award.
If I withdraw from graduate school after one semester (or quarter), I will forfeit the remainder of the award.
All the information stated herein is true and correct to the best of my knowledge. Swearing to false statements may cause forfeiture of any award and may demand repayment.
| Applicant's Signature:______________________________________________________________________ |
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Date___________________________________________________________________________________ |
Return Application to:
Ginny Ruckman
2710 House Ave.
Clark Building, 302
Cheyenne, WY 82001
gruckman@uwyo.edu