Joint Engineering Program

University of Missouri- St, Louis • Washington University in St. Louis

University of Missouri - St. Louis/Washington University Joint Undergraduate Engineering Program SCHOLARSHIP APPLICATION

ELEVATE YOUR FUTURE. ELEVATE ST. LOUIS.

I.	APPLICANT'S INFORMATION

Please TYPE the following Scholarship Information Page
RETURN TO: Joint Undergraduate Engineering Program
One University Boulevard
B216 Benton Hall 
St. Louis. MO 63121-4499

Name: 	

Address: -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Telephone:_. ____________   Birthdate:: _____________ Marital status:___ U.S Citizen?:      Yes    No
Number of dependents: _____                  Major: _______                  UMSL Student Number: (if applicable):_______________

II.	EDUCATIONAL EXPERIENCE  AND PLANS
Name of School Or
I	College	I	Address	Years Attended	Degree or College Credit Hours Earned	GPA	

					

					

    Current UMSL cumulative grade average: __________Anticipated Graduation Date__________________
Credit Hours earned to date  : __________
Number of hours enrolled this semester :	

Ill. FUTURE PLANS

What are your plans after graduation from UMSL?  (Be specific a s possible)

(Please continue on the back)

University of Missouri- St. Louis
B216 Benton Hall, One University Blvd, St. Louis, MO 63121

Washington University in St. Louis
            Campus Box 1130, One Brookings Drive, St. Louis MO 63130

IV.	ACTIVITIES

Please list any university or community activities in which you have participated:

Additional information may be submitted in the remaining space or you may attach additional pages as necessary.

V.	FINANCIAL RESOURCES

If employed, place of employment: 	
If employed, does your company assist in educational fees payment? 		
If so, what percentage is paid by your employer? 	

   Do you have other financial aid or a scholarship to help in paying your educational fees?  Yes. 		No.    	

If yes, please specify sources and amounts:

Source	Amount	

		

What amount of scholarship funds are you requesting? 	_

VI.	STUDENT'S AUTHORIZATION AND RELEASE FOR INFORMATION

I hereby authorize the Joint Engineering Scholarship Committee of the University of Missouri-St. Louis to examine academic and financial records, which apply to me when considering my application for this scholarship.

Signature of Applicant	Date