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APPLICATION FOR
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J.W. THURMAN ALUMNI SCHOLARSHIP
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National Alumni Association
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Eastern Kentucky University
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| Name________________________________________ |
Gender____ |
Date of Birth_____________ |
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| Address_____________________________________________________________________ |
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Street |
City |
County |
State |
Zip |
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| School ____________________________ |
Date of Graduation _____________________ |
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| Parents ____________________________________________________________________ |
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Father's Name |
Date of Graduation |
Occupation |
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______________________________________________________________________ |
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Mother's Full Name |
Date of Graduation |
Occupation |
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| Social Security Number ___________________ |
E-mail Address _________________________ |
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| Number of School Age Children in Your Family ______________________________________ |
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| Course of Study in High School |
_______ Advanced |
_______General |
_______ Other |
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| Cumulative Grade Point (Based on 4.0) _____________ |
ACT Composite ____________ |
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| Number in Graduating Class _________________ |
Year Rank ____________________ |
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| High School Honors: |
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| Other Activities: |
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| Intended Course of Study at EKU ________________________________________________ |
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___________________________________________________ |
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Students Signature |
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| By signing, I understand and agree to abide by the
requirements/terms described in the scholarship brochure, verify that
all information I have provided is accurate. If you are currently
at EKU, this signature gives permission for the Scholarship Committee
to review any academic records. |
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PLEASE RETURN ALL MATERIAL IN ONE ENVELOPE
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521 Lancaster Avenue :: Richmond, KY 40475 :: (859) 622-1000