Tennessee Tech University
Application for the Wilma Carr Scholarship
DEADLINE: December 15, 2018
Name: ______________________________________________ T Number_______________________
last first middle
street city state zip
Phone number (optional)________________ How may we notify you?______________________________
Term of Intended Enrollment: Fall 2019________Spring 2020_______ Summer 2020_______
Student Status: Full-time_____ Part-time_____ GPA in good standing? (2.0 or better)__________
Do we have permission to verify your grades? ____________Anticipated graduation date: _____________
Are you currently receiving a scholarship(s) _____Yes _____No If yes, please list the amount(s) and name(s) of
scholarships. In addition, please list any other financial assistance you are receiving.
Name Amount
Employer Name Average No. of Hours
Worked per week Dates Employed Responsibilities
All applicants must submit a statement of goals (200 words or less) to complete the scholarship application. Please
tell us why this scholarship is important to you. (attach separate sheet)
TELL US ABOUT YOUR SITUATION (attach separate sheet)
Any information on this application will be held in strict confidence.
Please note: Students must also complete the general scholarship application in ScholarWeb by December 15.
Tennessee Tech University
Cookeville, Tennessee
Because of public law (The Family Education Rights and Privacy Act of 1974, commonly known as the Buckley
Amendment), it is now illegal to divulge certain information contained in a student’s record without the student’s
expressed authorization and knowledge. It is, therefore, necessary to have the following authorization in order to
comply with the law and the request as described below:
I hereby request and authorize the release of information contained in my student records at Tennessee Tech
University to the appropriate departmental scholarship selection committee for the purpose of evaluation and
scholarship award selection.
Also, I hereby authorize the Wilma Carr Scholarship Committee to verify information contained on my application
that may be material to my qualifications for the Wilma Carr Scholarship.
Again, all information will be kept in strict confidence.
Student’s Signature ________________________________ Date___________________
All applications will be reviewed and evaluated by a select committee. ALL applicants will be notified by March 31, 2019 regarding the status of
their application submission. In order to protect the identity of the awardee(s), this application is not on Scholar Web and must be returned to the
Women’s Center.
Please return application to: Tennessee Tech University
The Women’s Center
Roaden University Center 339
P.O. Box 5216
Cookeville, TN 38505
For more information please contact: The Women’s Center - 372-3850 - or email at
womenscenter@tntech.edu. For security reasons, please do not return via email,
but hand deliver or send via post.
Rev 11/18
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University Use Only
Date received___________________ Received by__________________________________