Department of History

Application for History Department Scholarships

Return your completed application to the History Department office, Strong Hall 410, Missouri State University, 901 S. National Avenue, Springfield, MO 65897. The deadline for turning in completed applications for 2010-2011 scholarships is March 31, 2010.

By submitting this application, the applicant consents to the release of their contact information and FAFSA results to the selection committee for purposes of scholarship selection, as well as to the donor (and his representative) for purposes of acknowledgement. Students wishing to claim financial need should complete and submit their FAFSA form to the MSU Office of Student Financial Aid at least two weeks before the scholarship deadline:

Contact the History Department directly for information regarding scholarships (417) 836-5511. Applicants will be considered for all History Department scholarships for which they are qualified.

1) Name___________________________________________________________________________
First Middle Last

2) Social Security Number___________________ Birthdate_________ Female______ Male______

3) Address__________________________________________________________(___)__________
Street City State ZIP Phone

4) What is your Major course of study?:______________________ Minor_____________________

Classification: Freshmen_____ Sophomore_____ Junior______ Senior_____ Graduate_____

Degree Program: BA____ BSED____ MA____ MSED____

5) Are you a transfer student? Yes____ No____

If yes, please specify other collages, dates of attendance and credit hours earned:

College________________________________ Dates Attended____________Credit Hours________

College________________________________ Dates Attended____________Credit Hours________

6) Total Missouri State credit hours completed __________

Grade Point Average (GPA) for all Missouri State courses ________

Total credit hours completed (including transfer credits) ____________

Grade Point Average (GPA) for all credit hours (including transfer credit)_______

Total credit hours in US History completed ___________________

Total credit hours in non-US History completed ________________

GPA for all college-level History courses completed _____________

List of courses in progress this semester:

_____________________ _____________ _________________________________________________________
Course Code and Number Semester hours Course Name

7) Did you graduate from a rural Missouri high school? Yes_____ No_____
This gives you a preference for the Geisler scholarship

8) Have you been out of school and are returning to school this semester? Yes_____ No_____
Women over 30 years of age who are returning to school get preference for the Hickman Scholarship

9) Are you a member of the Theta Mu Chapter of Phi Alpha Theta? Yes____ No____
This is required for the Phi Alpha Theta Scholarships.

10) When do you expect to graduate from Missouri State University? Fall__ Spring__ Summer__ Year___

11) Have you worked, interned, or volunteered at the History Museum of Springfield-Greene County?
Yes____ No____ This is required for the Duane G. Meyer Endowed History Scholarship

12) School and community activities: List organizations to which you belong, any offices held and appropriate dates.

You may attach a separate page for additional activities.

Organization Name Offices Held (dates in office) Dates of Membership

a. ____________________ ____________(__________) from_________to___________

b. ____________________ ____________(__________) from_________to___________

c. ____________________ ____________(__________) from_________to___________

13) Special Recognition/Achievements: List awards and honors your have received.

__________________________________________________________________________________

14) Describe your academic goals and career plans. (you may attach another sheet)____________

__________________________________________________________________________________

I consent to the release of the above information provided as well as the results of my FAFSA for the purpose of evaluation
by the Missouri State Scholarship Committee or their appointed representatives.

Signature:_________________________________________ Date_______________________

Missouri State University is a community of people with respect for diversity. The University emphasizes the dignity and equality common to all persons and adheres to a strict nondiscrimination policy regarding the treatment of individual faculty, staff, and students. In accord with federal law and applicable Missouri statutes, the University does not discriminate on the basis of race, color, religion, sex, national origin, ancestry, age, disability, or veteran status in employment or in any program or activity offered or sponsored by the University. In addition, the University does not discriminate on any basis (including, but not limited to, political affiliation and sexual orientation) not related to the applicable educational requirements for students or the applicable job requirements for employees. This policy shall not be interpreted in a manner as to violate the legal rights of religious organizations or military organizations associated with the Armed Forces of the United States of America. The University maintains a grievance procedure incorporating due process available to any person who believes he or she has been discriminated against. Southwest Missouri State University is an Equal Opportunity/Affirmative Action employer. Inquiries concerning the grievance procedure, Affirmative Action Plan, or compliance with federal and state laws and guidelines should be addressed to Jana Estergard, Equal Opportunity Officer, Park Central Office Building (PCOB) 111, 901 South National Avenue, Springfield, Missouri 65897, (417) 836-4252.