THE UNIVERSITY OF NORTH CAROLINA AT PEMBROKE
APPLICATION FOR SCHOLARSHIP
 Department of Social Work

NAME_____________________________________________ DATE  ________________________

STUDENT ID  ________________________ EMAIL ADDRESS ____________________________

CAMPUS ADDRESS________________________________PHONE_________________________

HOME ADDRESS___________________________________PHONE________________________

Answer the following:
      1. I have received a departmental Scholarship in the past:  Yes    No
      2. I have received (place an "X" on the appropriate line):
                    ______ North Carolina Tuition Grants
                    ______ Pell Grant
                    ______ Supplemental Educational Opportunity Grant
                    ______ North Carolina Student Incentive Grant Program
                    ______ Vocational Rehabilitation Scholarships
                    ______  Minority Presence Grant
                    ______ American Indian Student Legislative Grant
                    ______ Other type of financial aid not listed above
        3. My overall GPA is: ________                       Registrar's initials: _______
        4. My major GPA is:   ________                       Registrar's initials: _______
        5. My major is: _______________________    Minor: ________________
        6. Present rank {circle} :  Senior;   Junior;   Sophomore;   Freshman
        7. I am a full time student :   Yes     No
        8. I am applying for:
                   ______ Maurice Bodenstein-Holocaust Memorial Scholarship in Social Work
                   ______ Margaret Kennerdell George Endowed Memorial Scholarship
                   ______ Von S. Locklear Endowed Memorial Scholarship in Social Work
(Must be Native  American to apply)
                   ______ Jetter Bernard Locklear Memorial Endowed Scholarship
(Must be Native  American to apply)
                   ______ Maria O'Neil McMahon Endowed Achievement Award
(Must be a graduating Senior to apply)
_____ Social Work Faculty Scholarship
______ School of Arts & Sciences Scholarship for SWK Majors

            9. Type one paragraph about your career goal and attach it to this form. Make sure to
                read the description of the scholarship before you compose your paragraph.

         ___________________________________                               __________________
         Signature                                                                                     Date

Your signature indicates that the above facts are accurate and that you give permission to the Department of Social Work to verify the statements.

Rev. 4/08