Texas A&M University-Texarkana
2015-2016 Academic Year Scholarship Application
Priority Deadline: April 1st, 2015


*  
*   * Date of Birth:
*      *  
* State                   *    
* Home Phone - - Work Phone - -
Cell Phone - - *          
Will you be graduating high school between May 1, 2015 thru August 15, 2015?
Will you be graduating from TISD(Texarkana Independent School District) between May 1, 2015 and August 15, 2015?
Have you ever attended A&M-Texarkana?

Number of children you support?   

Number of children 18 years of age or younger you support?   

How Many Hours do you plan to take at A&M-Texarkana?
     Fall 2015:    Undergraduate        Graduate
Spring 2016:    Undergraduate        Graduate


If you are seeking Teacher Certification, when will you Resident Teach?        (Semester/Yr)

  

  

  

Will you receive financial aid for the Fall and/or Spring semesters?  

Upon completion of your degree, do you plan to work in an occupation of service to " Benefit the Elderly "?  
**If yes, what organization?  


Are you a prior recipient of the Downtown Texarkana/Wilbur Smith Rotary Club Scholarship " at Texarkana Community College?  
**If yes, when?  


Is anyone in your immediate family a member of the Downtown Texarkana/Wilbur Smith Rotary Club "?  
**If yes, when?  


If you are applying for the Downtown Texarkana/Wilbur Smith Rotary Club Scholarship ", will you be willing to attend one club meeting each year and speak to the club at least once each year or semester?
**Please note that this is a requirement for this scholarship


The Dean and LaCrecia Barry Scholarship has specific requirements: 1) The recepient must partcipate 3 hours per week at the Runnin WJ Center 2) Must attend the Volunteer Banquet held in may of each year 3) Must attend the Horse Show held in May of each year. If awarded this scholarship, would you agree to fulfill these requirements?

If you are in the BAAS program, have you completed the portfolio class?  





Are you returning to college after an absence of at least five years in the Fall 2015?  
**If yes, when was the last semester you were enrolled in any college?     (Semester/Yr)


Are you proficient in Signed English or American Sign Language (ASL)?  
Did you ever attend Texarkana College?  




Please check or list any community organizations, volunteer services, or student organizations in which you have participated in the past 5 Years..

 Athletic Organizations           Investment  National Honor Society
 Animal Organizations           Kiwanis  PTA
 Band Boosters           Marketing  Randy Sams Shelter Volunteer
 Boy Scouts           Mass Communications  Red Cross Volunteer
 Church Organizations           Math  Salvation Army Volunteer
Club Organizations (Check all that apply)           Multicultural Assoc.  Special Olympics
           Accounting           Nursing  Student Government
          BAAS           Phi Theta Kappa  Student Tutoring
          Biology           Psychology  Who’s Who Among College Students
          Business           Reading  Who’s Who Among High School Students
          Choir           Rec Sports  Women's Leadership Organizations
          Computer           SAC Other:  
          Criminal Justice           SCEC Other:  
          Drama           SHRM Other:  
          Education           Sociology Other:  
          English         Other:   Other:  
          FBLA         Other:    
          FCA  Committee Organizations  
          FFA  Girl Scouts  
          History  Marathon for Specific Events (Race for the Cure, etc.)  


Are you related to any member of the Texas A&M System Board of Regents? These relationships include one of the following: Please select one:
  1. Not related
  2. Regents's - spouse, spouse's child, spouse's parent, child's spouse, parent's spouse
  3. Regents's - spouse's brother or sister, spouse's grandparent, spouse's granchild, brother or sister's spouse, grandchild's spouse
  4. Regents's - parent, daughter, son
  5. Regents's - brother, sister, grandparent, grandchild
  6. Regents's - great-grandparent, great-grandchild, uncle or aunt(brother or sister of parent), nephew or niece(son or daughter of brother or sister)
A list of the current Texas A&M University System Board of Regents members can be found at http://regents.tamu.edu/bios/.





ALL STUDENTS MUST COMPLETE THIS SECTION


Read and Check each Statement below:

   I certify that the information I have provided on this scholarship application is correct and was completed by me.
   I understand that submission of false or misleading information on this application may disqualify me from receipt of any scholarship award(s) and require me to repay any funds that are awarded to me based on false information.
  I give permission for information on this scholarship to be released to the donor or potential donors of any scholarship(s) for which I may be eligible. I also authorize publication of any award that I may receive.
   I understand that if the scholarship(s) for which I am applying requires submission of other documents, I must submit documents to the Financial Aid Office in order to be considered for the scholarship(s).
  I understand that all official transcripts must be on file in Admissions and any other Admission requirements must be fulfilled by the deadline in order to be considered for these scholarships.
To the student:    State law requires that you be informed of the following:  (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you.
By checking this box, I understand that this will serve as my electronic signature.

   
 


State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. For more information see our Privacy Statement.