TRIBAL PROGRAM NEWS
Siletz Scholarship 2003-2004
CTSI-Pepsi Scholarship 2003-2004
This scholarship is for students enrolled in a program leading to a degree in a
medical field. To apply for the Siletz Scholarship, please submit the following:
To apply for the CTSI-Pepsi Scholarship, please submit the following:
1) Documentation of acceptance at an accredited vocational training or higher
education institution, two-year, four-year, or graduate school
2) 500-word essay addressing the annual theme: Describe your major area of
study and its importance to you and the tribe.
3) One letter of recommendation
1) Documentation of acceptance at an accredited vocational training or higher
education institution, two-year, four-year, or graduate school
2) 1,000-word essay addressing the annual theme: Tell us about the most
inspirational person in your life.
3) One letter of recommendation
Essays will be judged on content, organization, and development of theme,
and use of proper grammar, spelling, and punctuation.
Awards: $500 (up to three awards per year). Scholarship may not be awarded
unless a minimum of two applications are received.
Essays will be judged on content, organization, and theme development, and
use of proper grammar, spelling, and punctuation.
Awards: $ 1,000. Scholarship may not be awarded unless a minimum of two
applications are received. This scholarship is made possible through a generous
donation by Pepsi, Inc.
Personal Information
Personal Information
Last name:First name:MI:
SSN:Date of birth:Tribal Roll No.:_________
Current mailing address:_________________ ___ ______________ __________
City:State:_______________ ZIP:_____________
Permanent mailing address:___________________________ _ ___________ _
City:State:ZIP:___________
Home phone:Work phone:
Last name:First name:MI:
SSN:Date of birth:_______ Tribal Roll No.:_________
Current mailing address:____________________ ________________________
City:State:ZIP: ___________
Permanent mailing address:_______________ ___ ____________________ ___
City:State:ZIP:___________
Home phone:Work phone:
Education History
Education History
High School: □Public □Other
Graduation/GED date:
Higher Ed/AVT Program: DAA DAS DBA DBS DGraduate
Graduation date:Degree received:______________ __
College/University:Major:
High School: nPublic □ Other
Graduation/GED date:
Higher Ed/AVT Program: DAA DAS DBA DBS □ Graduate
Graduation date:
Degree received:
College/University:Major:
Present Degree Program (2003-2004 Academic Year)
Present Degree Program (2003-2004 Academic Year)
Start date:Major:
College/University: Degree name:
Degree abbreviation:Graduation date:
Start date:Major:__________
College/University: Degree name:
Degree abbreviation:Graduation date:
Photo: Please submit a photo of good quality for use in newsletters and other
CTSI publications, preferably one in your school or work environment.
Note: Photo is optional and does not reflect on scholarship eligibility.
Photo: Please submit a photo of good quality for use in newsletters and other
CTSI publications, preferably one in your school or work environment.
Note: Photo is optional and does not reflect on scholarship eligibility.
Certification
Scholarship funds are to be used for academic purposes only.
By accepting the scholarship, I agree to advertising and promotional use of
my name, picture, and biographical information. I understand that:
Certification
Scholarship funds are to be used for academic purposes only.
By accepting the scholarship, I agree to advertising and promotional use of
my name, picture, and biographical information. I understand that:
/ hereby certify that the information provided on this form is true, correct,
and complete to the best of my knowledge. I consent to the release of this
information to other agencies and persons as necessary to determine my eligibility,
budget, and financial need.
/ hereby certify that the information provided on this form is true, correct,
and complete to the best of my knowledge. I consent to the release of this
information to other agencies and persons as necessary to determine my eligibility,
budget, and financial need.
Applicant’s signature:Date:
Applicant’s signature:
Note: Applications must be received in our office by 4:30 p.m. on June 27,2003.
Incomplete applications will not be considered. All correspondence will be
mailed by certified mail to permanent address unless otherwise requested in writing.
If you have any questions, please call Bev at 1-800-922-1399, ext. 290, or
541-444-8290. Please send applications to Bev Youngman, Programs Manager,
CTSI, P.O. Box 549, Siletz, OR 97380-0549.
Scholarships are awarded at the Nesika Illahee Pow-Wow, the second
weekend in August.
Note: Applications must be received in our office by 4:30 p.m. on June 27,2003.
Incomplete applications will not be considered. All correspondence will be
mailed by certified mail to permanent address unless otherwise requested in writing.
If you have any questions, please call Bev at 1-800-922-1399, ext. 290, or
541-444-8290. Please send applications to Bev Youngman, Programs Manager,
CTSI, P.O. Box 549, Siletz, OR 97380-0549.
Scholarships are awarded at the Nesika Illahee Pow-Wow, the second
weekend in August.
I
I
I
I
June 2003 □
Date:
Siletz News
□
11