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Staff Council Scholarship Application

Artist: Ashley Willess, 2017

Application Deadline:

October 1 (Fall) and March 1 (Spring)

Awarding of the Staff Council Scholarship is contingent upon an applicant's successful

completion of credit-granting courses during the semester in which the applicant applies.

Scholarship funds serve as a reimbursement for completed courses and may not be withheld

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SAMPLE APPLICATION

for future use. Student workers are not eligible for the scholarship.

UT Dallas staff members interested in applying for a Staff Council Scholarship must:

Attend a community college, university, or accredited vocational school

Have been employed for a minimum of six months at UT Dallas

Maintain a minimum overall GPA of 2.5 for undergraduate or 3.0 for graduate work

Submit completed application by stated deadline which includes the required essay

Be benefits eligible. (Graduate Assistants are not eligible)

If you have any questions, email [email protected] or contact the Staff Council

Benefits Chairperson, Jennifer Klunk, at x3525.

Personal Information

UTD-ID

Your UTD ID number is being requested because it is a unique identification number that is maintained for

tracking purposes, to ensure that the correct student record is being updated, and for state and federal

reporting requirements. The disclosure of your ID number is voluntary.

Last Name

First Name

Address

City

State

Zip

Telephone Number(xxx-xxx-xxxx)

UTD eMail Address


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UT Dallas Employment Information

Honors and Awards

Please list honors received within the last 5 years and the date of when the honor was

awarded. These include academic honors and awards for both civic and community honors

or awards.

Activities and Service

Please list activities participated in within the last 5 years and the dates of participation.

These include academic clubs and memberships for both civic and community clubs or

memberships beyond the scope of your employment.

Department Name

UTD Hire Date(mm/dd/yyyy)

Organization Honor/Award ReceivedDate of Honor/Award (mm/dd

/yyyy)

1

2

3

4

5

6

7

8

9

10


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Please list total participation hours and description of volunteer duties, if any.

College/University Attending

College/University Attending

Academic Information

Duration Duration (Dates of Service)

Organization RoleTotalHoursServed

Start Date(mm/dd/yyyy)

End Date(mm/dd/yyyy)

1

2

3

4

5

6

7

8

9

10

Undergraduate

Graduate


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Is this your first semester in the program?

Please list GPA (calculated on a 4.00 scale)

ESSAY (required)

Please explain how your educational goals support the university and how this scholarship

would assist you in attaining those goals. Your essay should not exceed 500 words.

Yes

No


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I certify that the information provided in this application is complete and accurate. I

understand that providing false or misleading information may disqualify me from

consideration of my application or disbursement of scholarship funding. I authorize release

of this information for any scholarship and/or recommendation purposes.

With few exceptions, you are entitled, upon your request, to be informed about the information UT Dallas collects about you. Under

sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section

559.004 of the Texas Government Code, you are entitled to have UT Dallas correct information about you that is held by us and that

is incorrect. Your UT Dallas records are protected from unauthorized disclosure by federal law.


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