Siletz news /, June 01, 2007, Page 15, Image 15

TRIBAL PROGRAM NEWS
2007-2008 Application Form
Pepsi - Craig Whitehead Scholarship
2007-2008 Application Form
Siletz Scholarship
Application Due Date: June 30, 2007
Application Due Date: June 30, 2007
Pepsi Inc. donates scholarship funds to the Siletz Tribe and has asked that this
scholarship be the Pepsi - Craig Whitehead Scholarship in honor of Craig Whitehead.
This scholarship is open to any field of study. To apply, please submit the
following:
This scholarship is open to all fields of study. To apply for the Siletz Schol­
arship, please submit the following:
1. Documentation of acceptance at an accredited vocational training or higher
education institution, 2-year, 4-year, or graduate school
2. A 500-word essay addressing the annual theme
3. One letter of recommendation
1. Documentation of acceptance at an accredited vocational training or higher
education institution, 2-year, 4-year, or graduate school
2. A 1,000-word essay addressing the annual theme
3. One (1) letter of recommendation
Essays will be judged on essay 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.
Essay Theme: Describe your major area of study and its importance to you
and the tribe.
Essays will be judged on content, organization and development of theme,
and use of proper grammar, spelling, and punctuation.
Awards: $1,000. Scholarship may not be awarded unless a minimum of two
applications are received.
Essay Theme: Tell us about the most inspirational person in your life.
Personal Information
Personal Information
Last Name
SSN
Current Mailing Address
City
Home Phone (
Last Name
Date of Birth
Current Mailing Address
First Name MI
Date of Birth
Tribal Roll No.
Permanent Mailing Address
State
ZIP
City
)Work Phone (
City
Home Phone (
State___ ZIP
)
First Name MI
Tribal Roll No.
Permanent Mailing Address
ZIP
State
)___
City
___ Work Phone (
State
ZIP
)___________
Education History
Education History
High School ( ) Public ( ) Other
Graduation or GED Date
Higher Ed/AVT Program ( ) AA ( ) AS ( ) BA ( ) BS ( ) Graduate
Graduation Date
Degree Received
College/University
Major
High School ( ) Public ( ) Other
Graduation or GED Date
Higher Ed/AVT Program ( ) AA ( ) AS ( ) BA ( ) BS ( ) Graduate
Graduation Date
Degree Received
College/University
Major
Present Degree Program (2007-2008 Academic Year)
Present Degree Program (2007-2008 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:
I 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.
I 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.
___ Date -------------------
Applicant’s Signature
Applicant’s Signature
Date --------------------
r------------------------------------------------------------------------------------------------------
Note for All Scholarships
• Application must be received in our office by 4:30 p.m. on June 30, 2(X)7.
• Incomplete applications will not be considered.
I • All correspondence will be mailed to permanent address unless other-
I
wise requested in writing.
I • If you have any questions, please call Bev Youngman at 1-SOO-922-1399.
I
ext. 1290, or 541-444-8290.
I
|
Please send application to Bev Youngman. Programs Manager, Confed-
| erated Tribes of Siletz Indians, P.O. Box 549, Siletz, OR 97380-0549.
Scholarships are awarded at the Nesika lllahee Pow-Wow,
the second weekend in August.
|
Fashionable Siletz Head Start students sport their choice of designer shades.
June 2007
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Siletz News
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