FACULTY/STAFF SCHOLARSHIP

DEADLINE: April 4, 2008
Criteria & Process: http://www.unomaha.edu/~facsen/Paul_Beck_Schlrshp/beck_application.htm

Please print off, fill out, and return this completed application, and other required documents, directly to the office of the Faculty Senate of the University of Nebraska at Omaha, ASH 105. (Only one application/category per student permitted.)

1. NAME _____________________________________________________________________________
Last First M.I.

2. Address: ____________________________________________________________________________
Street/P.O. Box

____________________________________________________________________________
City State Zip

3. Telephone: ___________________________ 4. E-mail Address: ________________________________

5. Gender: [ ] Male [ ] Female 6. Date of Birth: __________________________________

7. UNO Student I.D. #:_______________________________

8. University/college GPA: _________________________

9. Expected College Grade Level for 2008-2009:

[ ] UNO Senior [ ] UNO 5^th Year [ ] UNO Undergrad [ ] UNO Graduate

10. Expected UNO enrollment status for 2008-2009: [ ] Full-time [ ] Part-time

11. Declared Major or program of study at UNO: ______________________________________________

12. List activities/organizations with which you have been involved in:

_________________________________________________________________________________

13. List leadership position(s) you have held:

_________________________________________________________________________________

14. List awards and special recognitions/achievements you have received:

_________________________________________________________________________________

15. How will your university program of study assist you in achieving your personal and career goals?

_________________________________________________________________________________

16. Why is a university education at UNO important to you?

_________________________________________________________________________________

I certify the above information to be accurate and correct. I authorize the University of Nebraska at Omaha to release any information which may be required by University personnel or scholarship donor(s) to determine my eligibility to receive scholarship assistance.

Signature: _______________________________________________ Date: ________________________

The Faculty Senate - University of Nebraska at Omaha - ASH 105 - 6001 Dodge St. - Omaha - NE - 68182