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NEVADA WOMEN'S FUND SCHOLARSHIP APPLICATION

MUST BE RECEIVED BY NWF OFFICE BY FRIDAY, MARCH 21, 2008


Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Social Security # :
Age:
Email Address:
Nevada Resident:YesNo
If 'Yes', then how long:
If 'No', What is your Hometown:
ADDITIONAL INFORMATION:
(Please note: this information will be used for internal purposes only and will not be attached to any specific applicant in NWF reporting documents.)
Martial Status:SingleMarriedWidowedDivorced
Partners Name:
Partners Occupation:
Number of Dependants:
Ages (Seperate with Comma):
Race or Ethnic Background:
EDUCATIONAL PROGRAM FOR WHICH SCHOLARSHIP IS REQUESTED
Are you a...First time ApplicantorRenewing Applicant
Renewing applicants please indicate most recent year NWF scholarship received:
Proposed field of study:
School you will/plan to attend:
Address of School:
Will you attend: or
Date course or term is scheduled to begin (mm/dd/yyyy):
When do you expect to complete this course of study (mm/dd/yyyy):
Anticipated degree or certificate:
Presently enrolled:
Accepted for enrollment:Yes
Fall Enrollment:
If enrolled in a four-year education program, what is your status (freshman, sophomore,junior, or senior?):
Educational Background: Please list the most recent school and/or training course attended, dates, field of study and degree received or current status:
*Renewing applicants may proceed to Purpose Statement. New applicants please continue.
INCOME / EXPENSES
(Please provide annual financial information based on the most recent calendar year, Jan. – Dec.)
Income Source $ Amount Expenses $ Amount
Job Earnings Tuition &Fees
Savings Books &Supplies
Financial Aid
(grants/loans)		 Housing,
Utilities & Food
Scholarships Transportation
Relatives Day Care
Other Income
(Unemployment,
social security, etc.)		 Other Expenses
Total Total
These funds are used to supportpeople.
Please indicate any unusual expenses or other pertinent information that would be helpful in assessing your financial need:
List other sources you have applied to for educational assistance and amounts requested and received (including government assistance and Millennium Scholarship):
WORK EXPERIENCE
List your work experience for the last three years in chronological order.
Employer Position Dates of Employment Hours per Week
PURPOSE STATEMENT (New and Renewing applicants):
Include a typed statement (150-200 words). The statement should:
  • Describe why you want to further your education and three personal attributes you think will help you as you pursue your advanced degree. Include a discussion about your long-term career and personal goals.
  • Comment on an accomplishment(s) of which you are proud and/or activities with which are involved that have been of value to you.
  • Reflect upon any challenges or life experienced you have faced and how you have responded to them.
REFERENCES: New applicants please supply NWF with three signed and dated reference evaluation letters, at least one from a teacher or academic advisor and one from a work or volunteer supervisor. Please provided contact information for references.
*RENEWING APPLICANTS:
Please include a 150 – 200 word purpose statement update which may include any changes to your educational goals and/or any challenges or changes to your personal situation that have impacted your progress:
Transcript #2 upload:
Reference letter #1 upload:
Reference letter #2 upload:
I certify that to the best of my knowledge the information contained in this application is true and correct and that the NWF has my permission to use un-attributed quotes about my experiences in marketing materials.
Signed: Date
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