Scholarship Application
2020 2021 Academic Year
Please complete all sections of this application. The deadline for submission is April 1, 2020.
Section 1. Personal Information
Name: Date of Birth:
Student ID Number:
Address at College: Permanent address:
Home Phone: Cell Phone:
Email address:
If you are selected, you will need to provide your social security number.
Section 2. Academic Information
Name of High School:
City/State: GPA Graduation Date: ______________
Colleges and Universities Attended:
Name of College(s): Credit Hours Completed Dates GPA
Classification: Continuing Student Returning Student (after a break)
Enrollment: 6-8 hours ______ 9-11 hours _____ 12 hours or more ______
Are you in a program that starts at the community college and then continues at NAU? ________
Anticipated Graduation Date ___________Career Goal ___________________________________
Section 3. Work, Community Service, Activities and Interests
A. List and briefly describe any work experience starting with your most recent job.
Employer Position Dates Hours per week
Briefly describe your work responsibilities:
B. List and briefly describe your volunteer/community services activities.
Organization Involved Position Held Date of Involvement
Briefly describe your responsibilities.
C. List and briefly describe your extracurricular activities (e.g. memberships in organizations,
sports, etc.).
Organization Activity Dates of Involvement
Briefly describe how you participated.
D. List honors or academic awards you have received (e.g. scholarly activities, research, etc.).
Award/Honor Institution/Organization Date
E. Please list other scholarships you are receiving or have received with dates and amounts.
Section 4. Applicant’s Personal Statement
The applicant must submit, on a separate sheet of paper, a personal statement including the
Educational and vocational plans and goals;
Statement of financial need;
Life experiences, personal circumstances and any other information that would be
helpful to the scholarship committee in making its decision.
Section 5. College Official Verification
This section must be completed by the Office of Scholarships/or Financial Aid.
Cumulative grade point average:
College credit hours earned:
Semesters completed: __________
Eligible for financial aid: Yes No____
Verification by
Print Name Title Date____________
Name of College or University _________________________________________________________
I certify that the information contained in this application is correct and complete. By
signing below, I give permission my college of attendance to release transcript and
financial aid information to the University Women of Sedona Scholarship Committee to be
used solely for making scholarship award determination. The information contained
herein will not be shared with any other party or used for other purposes.
Signature of Applicant ____________________________________________ Date ______________
Note: Deadline for applications is April 1, 2020
Please submit application to:
Debbie Nellis, Ed.D.
Chairwoman, Scholarship Committee
University Women of Sedona
PO Box 20123
Sedona, AZ 86341
954 803-6992