logo Application#

STEPHENSON FAMILY SCHOLARSHIP APPLICATION FORM

RETURNING STUDENTS -- YEAR 2, 3, OR 4

STUDENT APPLICATION - STUDENT MAJORING IN HEALTH RELATED
OR BUSINESS FIELD

Only full time students are eligible -- minimum of 12 credit hours.
Please type or print legibly, using ink.
Failure to complete all information required will result in disqualification of applicant.

Return this form no later than April 2, 2012, to

Murray School
Stephenson Scholarship
216 Sherman St
Murray, Ia. 50174

or email to msfscholarships@gmail.com

Put personal information on this sheet only. A number will be assigned each application and selection
will be made with no knowledge of the individual identity of the applicants.


Student Name

Address

City   State   Zip

Telephone Number
 

By submitting this application, I certify that all information is true and accurate.

Date


Page 2 Application#

Stephenson Family Scholarship Application Form
Returning Students -- Year 2, 3, or 4

Educational Institution you are attending

Will you be attending the same institution next year?

If no, what college will you attend

Address of institution

Year in college next year

Major course of study

Cost of one year at this school:

Tuition
Room and Board
Books
Miscellaneous
(Please list)


College Activities, Awards, Honors (Please indicate if you have served in a leadership role.)

Have you done any volunteer work? If so, please describe.


Page 3 Application#

What responsibility will you take in paying for your own college?

Include an official college transcript for your first year of college.

Provide 2 letters of recommendation from your college instructors using the
2012-Stephenson-Returning-Student-Recommendation-Form

In a short statement (300 words or less) please explain why you are deserving of this scholarship.