Algernon Sydney/Mary Mildred Sullivan Award
2016 Application
Complete the form and save as an attachment using the following name:
Algernon_Sydney_/Mary_Mildred_Sullivan_Award_ 2016 (your name) and email
with your resume’ to registerr@winthrop.edu by 5:00 PM on March 8, 2016
Personal Data
Name:
Last
First
Middle
Student Number:
Sex: ___Male ___Female
Permanent Home Address:
Home Phone:
Local address:
Local telephone:
Educational Data
List all colleges at which you have taken courses for credit, including Winthrop:
Name of College
City, State
Dates attended
Major:
Minor:
Present Cumulative Grade Point Average:
Student Activity Data (Please tell us about your accomplishments including
information in the following areas):
Scholarship(s): List any academic scholarship award received and/or honor society
memberships, etc. Include any offices held and length of involvement.
Athletics: Include any participation in varsity sports, intramural, cheerleading, etc. and
length of involvement. List any athletic awards received and dates of presentations.
Campus Activities: Indicate any involvement in student organizations, memberships,
offices held, and dates of involvement. Include student government and social
organizations.
Publications: List your involvement in departmental and/or campus publications and
appropriate dates, including position(s) held. Give brief description of any works you
have had published in journals, newspapers, or magazines.
Speech, Music, Drama, & Other Arts: List any participation, performance or exhibition
in any of these areas, include awards received and dates.
Community or Civic Activities: List briefly any significant participation in
community/civic projects while attending college and include dates.
Given the criteria for this award, provide any additional information that you
believe is relevant regarding your application for this award.
Department of Student Affairs
Division of Student Life
February 2016