STUDENT APPLICATION

STUDENT APPLICATION FOR

SUSAN E. DEES SCHOLARSHIP
GLENDALE HEIGHTS JUNIOR WOMAN’S CLUB
$1000 Scholarship for 2008-2009

Deadline: May 21, 2008

PERSONAL INFORMATION:

Miss/Mrs./Ms. __________________________________________________________________________

First MI Last __________________________________________________________________________

Home Address: __________________________________________________________________________

Contact Info: Home Phone: _______________________________ Cell: _____________________________

E-mail: ___________________________________________________________________________________

EDUCATION INFORMATION: High School and College

List all previous educational institution(s) that you have attended
and the year you received or expect to receive a diploma or degree:

(1)____________________________________________________________________________________________________

(2)____________________________________________________________________________________________________

(3)____________________________________________________________________________________________________

Educational Institution I plan to attend in Fall ’08: _________________________________________________________

My intended area of study: _____________________________________________________________________________

SCHOOL and COMMUNITY INVOLVEMENT:

List any activities in which you have been actively involved.
Indicate the number of years of involvement including any offices held and/or special contributions.
(Please include both high school and college.)

____________________________________________________________________________________

List any extra-curricular activities you have your participated in, and indicate the nature of your involvement and length of time of service:

____________________________________________________________________________________

List your ambitions and goals:

____________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

EMPLOYMENT INFORMATION:

List your job experiences as well as significant enrichment activities in which you have participated:

____________________________________________________________________________________

FAMILY INFORMATION:

Name of parents or guardians:

Mr./Mrs./Ms. ___________________________________________________________________________

Home Address: _________________________________________________________________________

Are there any special circumstances which the scholarship committee should know in considering your application?

____________________________________________________________________________________

ACADEMIC INFORMATION:

GPA _______ YOU MUST PRESENT A CERTIFIED TRANSCRIPT OF YOUR GRADES

Applicant Signature: ________________________________________________

PLEASE FEEL FREE TO USE EXTRA PAGES TO COMPLETELY ANSWER ANY QUESTION.

Mail Application and Transcript no later than May 21, 2008 to:

Susan E. Dees Scholarship Committee

C/o Glendale Heights Junior Woman’s Club

P.O. Box 5584

Glendale Heights, IL 60139