MYRLE M. BURK – KAPPA DELTA PI
SCIENCE EDUCATION SCHOLARSHIP
APPLICATION FORM
Spring 2016
On February 7th, the thirty-seventh Myrle M. Burk-Kappa Delta Pi Science Education Scholarship will be awarded at a
special ceremony on the UNI campus. The Myrle M. Burk – Kappa Delta Pi Science Education Scholarship is open to
initiates and current members of the UNI Chapter of Kappa Delta Pi International Honor Society in Education.
Applicants must be active (current dues paid by 01/21/16) members or Spring 2016 initiates. This semester’s award will
be for $1500. See information statement mailed to you for further details.
Personal Statement
Name ________________________________________________
Student Number ___________________________
E-Mail _______________________________________________
Campus Address _____________________________________________________
Telephone ________________
Permanent Address ___________________________________________________
Telephone ________________
Semester of Initiation to Kappa Delta Pi ________________________________________________________________
Expected Semester of Student Teaching _________________________________________________________________
Major:

Elementary
__________________
concentration
GPA in Major ___________
Minor _________________

Middle School/Jr. High
__________________
subject areas
Overall GPA ___________

Secondary
__________________
subject areas
GPA in Science Courses ___________
Advisor ________________________________________
Other Post Secondary (Including Community Colleges) Attended _____________________________________________
Names of student organizations of which you are a member _________________________________________________
__________________________________________________________________________________________________
Voluntary (not for class) educational and service activities while at UNI _______________________________________
__________________________________________________________________________________________________
Honors received while at UNI _________________________________________________________________________
__________________________________________________________________________________________________
Work Experiences (including voluntary) related to education during the last four years ____________________________
_______________________________________________________________________________________________
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MYRLE M. BURK – KAPPA DELTA PI SCIENCE EDUCATION SCHOLARSHIP
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Career Objectives:
A.
Short Term _________________________________________________________________________________
B.
Long Term (if different) _______________________________________________________________________
Are you working to support your schooling at UNI?

YES

NO
If yes, Employer(s) __________________________________________________________________________________
Current Income
$ __________ Summer
Approximate Current Indebtedness
$ __________ Academic Year
$ ________ UNI Financial Aid
$ ____________ Total
$ ________ Other
Are you receiving financial aid for your tuition and/or room and board for this academic year?
Scholarships

YES

$ ________ Total

YES

NO
NO
2015–2016 Loan Total $ __________
Grant Total $ __________
Scholarship Total $ __________
Please attach a personal statement, of approximately one typewritten, single-spaced page, in which you express your
reasons for believing that you are qualified to receive the Burk – KDP Science Education Scholarship. If you are applying
for more than one KDP scholarship, a distinctly different statement must be submitted for each.
Please have two letters of recommendation submitted (by the writers) which can help the Selection Committee assess your
potential and interest in the teaching of the natural sciences. If you are applying for more than one KDP scholarship,
please have distinctly different letters submitted for each.
1. ____________________________________________________________________________________
Name
Address
Telephone
2. ____________________________________________________________________________________
Name
Address
Telephone
I, __________________________________ , hereby make application for the Burk-Kappa Delta Pi Science Education
Scholarship and authorize the Selection Committee to review my academic and financial aid records.
_________________________________________________________________________________________________
Signature
Date
Please forward your application and have your letters of recommendation sent directly to: Becky Hawbaker, KDP Faculty
Counselor, 462 Rod Library, University of Northern Iowa, Cedar Falls, IA 50614. The absolute deadline for receipt of
applications and materials is NOON on Thursday, January 21, 2016, so those who are interested should begin the
application process immediately! Candidacies of students with applications or letters received after that time will not be
considered. The recipient of the Myrle M. Burk – Kappa Delta Pi Science Education Scholarship will be announced
during the fall initiation program on February 7, 2016.