KENT STATE UNIVERSITY
COLLEGE OF APPLIED ENGINEERING, SUSTAINABILITY and TECHNOLOGY
2016- 2017 SCHOLARSHIP APPLICATION FORM
Date: _________________
Select the scholarship(s) for which you are eligible. Please review the criteria for each
scholarship at www.kent.edu/caest/industry/scholarship.cfm
___
Friends of Michael Dragomier Endowed Scholarship Fund
General Information (Print or type using blue or black ink)
Name _____________________________ Kent State ID ________________________
Local Address _________________________________________________________________
(Street)
(City)
(State)
(Zip)
County _________________________
Local Phone (
) _________________
Male ____ Female _____
Email Address _____________________________
Date of Birth ______ Marital Status ________________________
Class Standing Fall 2016 (Circle One) Incoming
FR
Officially Declared Major ________________________
Major GPA_________
SO
JR
SR
Graduation Date _____________
Cumulative GPA_________ Current hours _______________
KSU Semester Hours Completed __________ Transfer Semester Hours ______________
Please indicate the percentage of funding for college expenses (tuition, room/board, books,
miscellaneous). Total must equal 100%.
Parents___
Loans___
Federal Grants ___
Self___
Scholarships___
Extracurricular Involvement and Personal Interests
List extracurricular activities (college only) past and present. (Use an additional sheet of paper if necessary.)
Organization Name
Position Held
Dates
1. _____________
_______________
_____________
2._____________
_______________
_____________
3._____________
_______________
_____________
List any community activities (college only) past and present (additional sheets can be attached
to application, if necessary).
Association
Status
Dates
1. _____________
_______________
_____________
2. _____________
_______________
_____________
3._____________
_______________
_____________
4._____________
_______________
_____________
List any other scholarships, awards or achievements (college only) you have received (additional
sheets can be attached to application, if necessary).
Award Title
Date Awarded
1. _________________________________
________________________________
2. _________________________________
________________________________
3. _________________________________
________________________________
4._________________________________
________________________________
I hereby authorize the Scholarship/Award Committee to inspect any and all of my student
records.
_________________________________
Signature
____________________________________
Date
Return to:
Kent State University
College of Applied Engineering,
Sustainability and Technology
Office of Student Services
127 Aeronautics and Technology Building
1400 Lefton Esplanade
Kent, Ohio 44242
Application Deadline:
All materials must be received or postmarked by
April 18, 2016