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Please complete this application and mail it to: The Medalist Club Post Graduate Scholarship Chairperson P.O. Box 71996 Tuscaloosa, AL 35407 |
Name: __________________________________________________________________
Maiden Name: __________________________________________________________
Current Address: _______________________________________________(street)
__________________________________(city, state, zip code)
Year of Graduation from The University of Alabama: _____________________
Degree Earned from The University of Alabama: __________________________
Undergraduate Grade Point Average: _____________________________________
Honors and Awards earned at The University of Alabama: _________________
_________________________________________________________________________
_________________________________________________________________________
Extracurricular involvement at The University of Alabama: ______________
_________________________________________________________________________
_________________________________________________________________________
Current Employer: ______________________________________________________
Current Occupation: ____________________________________________________
Current Annual Income: _________________________________________________
Will you continue to work while enrolled in graduate school: Yes / No
Expected annual income while pursuing graduate degree: _________________
Potential financial support from other sources (i.e. parents, inheritance, interest income)
Source Dollar Amount
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Degree program currently enrolled in or accepted to:
School/University: __________________________________________________
Degree Seeking: _____________________________________________________
Will you be a full time or part time student: _______________________
Annual Tuition of Program: __________________________________________
Please submit your responses to the following questions on separate sheets of paper, typed and double-spaced. Please use no more than one page per question unless otherwise noted.
