NAME: UNO ID or SS#

Last First MI

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Permanent Address

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Other contact information:

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** Fund Requirements ** (You are eligible to receive payments only while all answers are yes.)

Are you a declared chemistry major in the UNO College of Arts and Sciences?

Have you successfully completed at least 27 CH of study?

If not, how many credit hours will you have completed by the end of the current term?

Is your GPA at least 3.0?

Will you be a regularly enrolled, full-time undergraduate during the period of the award?

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Student's Signature Date

Addressing the Criteria. Fill in the top of this page completely. If you have completed less than two full semesters at UNO, state your current grade in each of your classes.

Preference is given to candidates with demonstrated financial need. This is assessed by the UNO Office of Financial Aid. To demonstrate any need you must have submitted a current Free Application for Federal Student Aid (FAFSA), indicating UNO in the release section. See the UNO Office of Financial Aid (EAB103) for the necessary form and for information regarding quick filing options.

According to the agreement establishing the scholarship, preference is given to candidates who are employed and providing some of the costs of their education. So that employment might be assessed, identify the following for your current employer(s): name and address of your employer, name and telephone number of your supervisor who can verify your employment status. So that self-provision might be identified, state what educational costs have been met from your individual resources.

Submission. Submit this page. If submitting information to address the award criteria, place this on an additional, plain, 8½ x11" sheet headed with "2007 March Scholarship", your name and the date. This application is due by noon Wednesday March, 21 2007. Submit to the Chemistry Department office, DSC 337, to the attention of the Student Awards Committee. The postal address is University of Nebraska at Omaha, 6001 Dodge St., Omaha, NE 68182. FAX (402)554-3888.