APPLICATION FORM
MATHEMATICS DEPARTMENT SCHOLARSHIPS
Completed application forms should be submitted to the Chair of the Department of Mathematics
NO LATER THAN the third Friday in January of the year in which the scholarship is to be
awarded.
Name:
Class Standing (circle one): FRESHMAN
Major (circle one): MATHEMATICS
Credit Hours Earned:
SOPHOMORE
MATH TEACHING
JUNIOR
SENIOR
MATH-ACTUARIAL TRACK
Cumulative GPA (USI):
Math Class(es) in which you are currently enrolled:
Please list other scholarships or financial aid received:
Please list organizations, clubs, activities, or community service in which you participate.
Attach a one-page essay describing why you selected mathematics as a field of study and how you
envision using mathematics in your future career.
Signature____________________________________________________
Date______________________