UNIVERSITY OF WEST GEORGIA

Department of Mathematics

Scholarship Application

2008-2009

Before completing this form, please visit http://www.westga.edu/~math/scholarships.pdf for details. The deadline for Martin Crider Scholarship and Mrs Jewell Burson Calculus Award is 1/30/2009 and for the other scholarships is 3/2/2009. Return your completed form to the Department of Mathematics Office.

Please Print:

Name__________________________________________ ID__________________

Last First Middle

Which scholarship are you applying for?

1. Chatty Pittman Scholarship
2. David Cooley Scholarship
3. Dr. Georgia Martin Scholarship
4. Vachel Davis Whatley, Jr. Scholarship
5. Marion Crider Scholarship
6. Mrs. Jewell Miles Burson Calculus Award

Permanent Address _____________________________________________________

Number Street Apt. #____________________________________________________

City____________ State____________ Zip____________

Home Phone_______________ Campus Phone________________

Campus Address________________________________________________________

Regardless of where you are living while attending classes, list your home county below.

County _____________State ________________Dates of Residence_______________

High School___________________________________________________________

City____________ State____________ Zip____________

West Georgia Academic Major_____________

High School GPA _____ Transfer GPA _____ University of West Georgia GPA _____

Anticipated Graduation Date_____________

Please check your current status:

____Freshman

____Sophomore

____Junior

____Senior

Extra curricular activities_______________________________________________

In general, undergraduate students must be enrolled full-time (12 hours) to receive a

scholarship. List your intended hours of enrollment for each term.

Summer Session 2009__________

Fall Semester 2009__________

Spring Semester 2010__________

Signature of Applicant ___________________________Date__________________