Section 1 – Demographic information: provide and certify demographic information. Section 2 – Essay: write an essay of no less than 300 words on the topic provided.Section 3 – Estimated Costs and Income: provide an estimated cost of attending WSU for the

spring semester and your income.Section 4 – Participation: provide information for extra participation points.

Additional instructions are provided in each section.

Important note

Student Support Services Scholarship ApplicationSpring 2018

Applications are invited for SSS spring 2018 scholarships awards. Only current participants accepted into the program before July 31, 2017 are eligible to apply. Scholarships are awarded based on the following four criteria: 1) Essay, 2) Program participation, 3) Academic Achievement, and 4) Finan-cial Need.

Instructions

All applicants must complete sections 1, 2, 3, and 4 of the scholarship application.

1. Application must be fully completed.2. All essays must be typed and well- thought out3. Essays must be no less than 300 words4. Applications must be submitted no later than 4:00pm, October 31, 2017.5. Late or incomplete applications will be disqualified.6. Applications may be submitted via email to TRIO.SSS@wichita.edu.7. Scholarship awardees will be contacted by e-mail no later than November 15,

2017.

Section I: Name and Demographic Information(Please print neatly or type)

Name _______________________________________ myWSU ID_______________Last First M.I.

Telephone ____ - ______________ Email _________________________________

Certification:

I certify that the information I am providing on this application is true and correct to the best of my knowledge. I understand that this application is subject to review and verification. I also understand that any fraudulent information given will result in immediate disqualification. If I am a recipient of a scholarship, I agree to participate in various program promotional activities and submit a Thank You letter to the donor.

Applicant’s Signature ____________________________ Date ___________________ (Please enter your Initials)

Please describe below any unusual circumstances regarding you or your family’s financial situation that you would like us to consider (Answering this question is optional).

Section II: Essay myWSU ID _______________

Type a well thought-out essay of no less than 300 words on the topic below. Make sure to include your myWSU ID in the right-hand corner above.

Essay Topic: Name three services provided by Student Support Services that you have utilizedand benefited from. Explain giving examples of how these services have impacted your academic progress/success at WSU.

Minimum Word Count: 300 (You may copy and paste the Essay from a Word document)

Section III: Student’s Estimated CollegeCost and Income

myWSU ID _______________

COSTS Amount INCOME THE COSTS

Tuition Family Resources

Fees My Savings

Books/Supplies Scholarships

Equipment Grants

Room and Board Work Study/Job

Transportation My Federal Ed Loan(Perkins/Stafford)

Personal Expenses Parent PLUS Loan

Other (please list) Other Loans

Other ResourcesTotal Costs = Total Available to

meet costs

Section IV: Advocacy/Participation for Bonus PointsPlease provide information on your advocacy & participation activity for bonus points

A. Have you ever referred a student to SSS program?

B. Did your referral join the program?

C. What is the name of the student you referred tothe program?

D. Have you participated in Final Fun Fridays?

Spring 2017

April

Yes No

Yes

Yes

No

NoIf so, when?

Fall 2017

May

September

Section V: Scoring Section (To be completed by Scholarship Committee)FOR OFFICE USE ONLY

Advisor Section: Complete this section except for the total points. Use the current semester’s ser-vices received.

Completed financial literacy activity (1 pt.) Completed study skills activity (1 pt.)Advocacy points (1 pt.) Meeting with advisor (1 pt. per contact, maximum of 3 pt.)

Fin Lit/Study Skills Advisor Meetings

Grade Level GPATotal Costs Income EstimateAdvocacy/Referral Participation(e.g Final Fridays)

_____________________________ __________________Advisor’s Signature Date

Scholarship Committee Section: complete this section by using the rubric to score applicant’s essay

Evaluator 1 Evaluator 2 Evaluator 3 SubtotalTOPIC

CONTENTSPELLING & GRAMMAR

TOTAL SCORE: