2009-2010 Returning Student
Scholarship / Awards Application
PRIORITY DEADLINE IS DECEMBER 1, 2008
Notification of scholarships/awards will be made by April 30, 2009.
To ensure your best chance of receiving a scholarship, please fill out all fields complete as possible.
First Name: EMPLID: Optional: Male Female  
Last Name: Email: Date of Birth:
    SSN:    
Local Address: City: State:
  Phone # Zip Code:
Hometown Address: City: State:
Hometown address should reflect the address of family members for a scholarship ceremony invite. Zip Code:
  Country: County:
 
Other:
Other:
High School: City: State:
High School Graduation Date:    
Month/Yr of college graduation:  
Number of credit hours planned for Fall 2008 semester  
All returning students of Dickinson State University may apply for scholarships and awards that are awarded through the Dickinson State University Foundation Inc. Successful scholarship recipients must be enrolled as full-time students, be in good disciplinary standing and maintain a minimum grade point average of 2.0 in order to receive their scholarship or award.  It is the policy of the Dickinson State University Foundation to award December graduates with half of an annual award.
All applications will be sent to Student Development.
If you would like other departments and/or offices to receive a copy of this application, please check them below:
Department of Agriculture and Technical Studies
Department of Business and Management
  __ Department of Fine and Performing Arts
      Theatre Dance Art
Department of Health and Physical Education
Department of Language and Literature
Department of Mathematics and Computer Science
Department of Music
 Department of Natural Sciences
Department of Nursing
Department of Social Sciences
Department of Teacher Education/Psychology
Intercollegiate Athletics
Undeclared major
National Guard Member / Family
Other:
My intended major(s) are: and/or
My minor(s)/concentration(s) are: and/or
Home town
Name of home town newspaper
Address of home town newspaper
 
PLEASE COMPLETE A STUDENT ACTIVITY TRANSCRIPT (Below)
You will be matched with the appropriate scholarship through the information received on this application. Selection committees will use the record of all activities for each student in order to assist with choosing recipients.
Student Activity Transcript
Selection committees find it helpful to have a record of all activities for each student in order to assist with choosing recipients. Such information is also useful to faculty and staff members from whom you may want a recommendation in the future. If you are a junior, please indicate in the senior column which activities you plan to participate in during your final year at Dickinson State.
Please tell us how a scholarship would benefit you in your quest for a degree at Dickinson State University.
Please complete this section, beginning with your college career.

Employment History/Work-study Record
Year
Year
Year
Year
Year
Varsity Athletic/Intramural Participation
Year
Year
Year
Year
Music Participation
Year
Year
Year
Year
Year
Theatre/Dance Participation
Year
Year
Year
Year

Student Government (list position)
Year
Year
Year
Year
Campus Activity Board (list position, if any)
Year
Year
Year
Year
Student Publications
Year
Year
Year
Year
Scholarships
Year
Year
Year
Year

Other Clubs/Organizations (list offices, if any)
Year
Year
Year
Year
Other Activities (list on/off campus involvement)
Year
Year
Year
Year
Year
Year
Year
Year
Year
Awards and/or Honors
Year
Year
Year
Year

If necessary, please provide additional information.
By submitting this application, I hereby give permission to Dickinson State University to release the academic information contained in my student file to any scholarship committee for the purpose of scholarship consideration. Any scholarship committee may use this information to determine eligibility for a scholarship. I also hereby give permission to send news of the award to area news media and the donors.
Date:
Dickinson State University is an equal opportunity and affirmative action institution that does not discriminate on the basis of race, age, color, national origin, gender, or handicap in its admissions, employment practices, education progams, or other related activities. Inquiries regarding the educational opportunities or equal employment policies of the affirmative action program should be directed to: Affirmative Action Officer, Dickinson State University, Dickinson, ND 58601-4896 or Office for Civil Rights, U.S. Department of Education, Denver, CO 80294-3608.