Language Enrichment Scholarship Application Form
Overview: This scholarship is for non-native English speakers that desire to attend classes at Crowder College. It is available to students that would like to strengthen their English skills for a variety of purposes.
Award: The value of the scholarship is $500. It is renewable for three additional semesters if the recipient completes at least 12 credit hours per semester, and a 3.0 Grade Point Average is maintained each semester.
Qualification: Applicants must be non-native speakers that plan to attend Crowder College. Recipients will be selected on financial need, goals for the future, motivation for learning English, and visions for improving their skills and abilities through their education at Crowder College.
Procedure: Applicants must submit a completed application form. The application form must be received by February 15 to be considered. A campus committee will review applications and select finalists. Finalists will then be chosen and notified. Finalists will be asked to visit the Crowder College campus for an informal interview and placement test.
Contact: Jenny Stegall English Language Institute Crowder College 601 Laclede Ave. Neosho, MO 64850 jstegall@crowder.edu (417)455-5493
Name: Last First Sex: Male Female Date of Birth: Age: Address (No PO Boxes) * City State Zip Phone Number: Email Address
Marital Status Single Married Separated Divorced Widowed
Residency Status: US Citizen US Resident Other (explain)
How did you become aware of the scholarship? High School Place of business (where?) Other (please explain)
How do you rate your English skills and English abilities? Fluent Intermediate to High Basic to Intermediate Very Basic
B. Schooling
1. School Information I have a high school diploma I have my GED I am attending high school or GED classes now Other (explain)
2. Beginning with high school, list all high schools, colleges and universities you have attended including the dates of attendance and your grade point averages ( or equivalent).
High School
Location
Dates Attended
GPA ( Grade Point Average)
Graduated Yes No
Other
College/University
Have you ever studied English? Yes No
If so where If so for how long
C.Work
1. Employment history. Beginning with your current job, list your 2 most recent jobs.
Company Name for current Job(s)
Dates
Job or Kind of Work
Approximate Salary
Job or Kind of work
D. Family and Income Information
!. Are You independent (You support yourself) dependent (Some other person supports you)
2. Do you currently live with just yourself just yourself and your children friend both parents one parent just you and your spouse (husband/wife) you, your spouse and children other (explain)
3. Do you have any siblings (brothers/sisters) yes no (How Many)
Do any of your siblings live with you yes no (How many live with you)
4. Do you have children yes no (How Many) (How many of your children live with you)
5. Support. Who do you support just yourself just yourself and your children just you and your spouse (husband/wife) you,your spouse and children other (explain) I support nobody; I am a dependent
6. For dependents only. Who supports you both parents one parent other (explain)
7. Income.
what is your income before taxes /year
What is your spouse's income before taxes /year
If you are a dependent, what is the income of the people who support you /year
Does your family earn any income from other sources, (not from work) yes no If so how much
8. Are you currently eligible to recive any scholarships, financial aid, or other assostance with school? yes no
If so, explain
E. Questions
1. Why do you want this scholarship? How would the scholarship help you with your studies at Crowder College? Why should you be chosen to receive this scholarship?
2. Explain your goals for the next five years. Include academic, carer, and personal goals.
F. Signature and Date
By submiting this sheet electronically, I certify that i have read the requirements for the Language Enrichment Scholarship and that all information given is complete and correct.
Signature and date