ELEANOR DALEY SCHOLARSHIP
2008-2009 APPLICATION FORM
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ALL FIELDS MUST BE COMPLETED
Applications are due to Student Leadership Development and Volunteer Services no later than Monday, August 11, 2008.
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PERSONAL DATA
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All fields and questions must be completed. We are unable to accept incomplete applications.
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First Name
Last Name
UIN#
UIC Email
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Mailing Address
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City
State
Zip
Phone
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City of Chicago Resident
YES
NO
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High School Attended
Location
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Grade School Attended Location
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If employed, list place of employment and average number of hours worked per week.
Hours per week
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ACADEMIC DATA
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All fields and questions must be completed. We are unable to accept incomplete applications.
Answer the following questions based on your Academic Program for the 2008-2009 academic year.
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Level of undergraduate study that applies
Freshman (1-29 hours)
Sophomore (30-59 hours)
Junior (60-89 hours)
Senior (90 plus hours)
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Total credit hours earned through the 2007-2008 Academic Year
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Cumulative GPA
Academic College
Major/Discipline
Date Bachelors Degree Expected
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FINANCIAL AID INFORMATION RELEASE
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Please indicate your approval to have your records accessed in order to determine financial need for this scholarship.
I hereby allow access to my financial records
I hereby do not allow access to my financial records
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REFERENCES
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Please provide the names and contact information of two individuals who will serve as references for you and who can speak to your leadership and community service experiences and ability.
Name
Title
E-Mail
Name
Title
E-Mail
These two references will need to each provide a letter of reference speaking to your leadership and community service experiences and ability; the letter should also indicate how long and in what capacity they have known the applicant.
Original copies of the letters of reference must be received no later than Monday, August 11, 2008 via mail or delivery to
Student Leadership Development and Volunteer Services
c/o Valerie L. Holmes, Scholarship Chair
750 S. Halsted St
390 Student Center East (MC330)
Chicago, Il 60607
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LEADERSHIP AND COMMUNITY SERVICE ACTIVITIES RECORD
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List all significant campus activities, leadership roles, community service, and scholarships/awards. Include dates for each activity and scholarship/award. Please describe the criteria for the award if it is not obvious from the award’s title.
Campus Activities
Leadership Roles/Activities
Community Service/Community Involvement
Scholarships/Awards
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PERSONAL STATEMENT
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In a statement of up to 1000 words, please describe your personal journey through college. You should include reflections on obstacles overcome, campus/community involvement, the impact living in Chicago has had on your UIC experience, your financial circumstances, and career and life plans.
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Place your initials in the space provided, verifying that the information that you have provided is accurate and submitted at your own will.
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