Scholarship Application
CHIEF WASHAKIE ENDOWMENT
2016-17 Academic Year
The Chief Washakie Memorial Endowment at the University of Wyoming has been established
to help students and educators with significant ties to the Wind River Reservation community
gain formal knowledge, skills and abilities. The spirit of the award assumes that the recipients
have, as part of their ultimate goals, some direct participation, appropriate to their educational
background, in activities that will further the common good of the people of the Reservation.
Eligibility Requirements:
1. You must be admitted to the University of Wyoming.
2. You must apply for federal financial aid by submitting the Free Application for Federal
Student Aid (FAFSA) as soon after January 1 as possible. If FAFSA data is not received
by UW by March 1, 2016, your application may not be considered by the Committee.
3. You must submit this completed scholarship application by the published deadline.
4. Previous recipients may apply.
5. Applications will be accepted from full-time and part-time students, from UW Outreach
and on-line students, and from all class levels (including graduate/professional students
and second bachelor’s degree candidates).
Selection Criteria:
1. Scholastic ability, potential, and achievement
2. Involvement in school, community, and tribal activities
3. Potential to contribute to the Wind River Reservation community upon graduation
4. Financial circumstances
Amount of Awards: The Chief Washakie Memorial Awards Committee will competitively
award several scholarships, of one academic year’s duration, in varying amounts, dependent upon
the availability of funds and applicant qualifications. Yearly awards will be divided in half with
one half of the award paid at the beginning of each semester.
Award Conditions:
1. You must be enrolled in UW course work.
2. To receive a payment for the second semester, you must have earned a cumulative UW
grade point average (GPA) that allows you to maintain good academic standing (2.0 GPA
for undergraduate, pharmacy, and law students; 3.0 for graduate students).
3. If you apply for financial aid at UW based on your financial need and receive this
scholarship, the UW financial aid package offered to you may have to be adjusted to
reflect the addition of this scholarship. Other types of aid you were offered may be
reduced, but the total amount of your financial aid offer will not be reduced.
Application Submission: Applications should be submitted no later than March 1, 2016, to:
Chief Washakie Scholarship, c/o Debra Littlesun, Associate Director Office of Student Financial
Aid, University of Wyoming, Department 3335, 1000 E. University Ave., Laramie, WY 82071.
Questions may be addressed to Debra Littlesun by phone at 307-766-2411, by email at
dreed14@uwyo.edu, or in person in Knight Hall, Room 174 on the UW campus.
Application
CHIEF WASHAKIE scholarship
2016-17 Academic Year
Please print or type.
APPLICATION DEADLINE: March 1, 2016
1. Name _______________________________________________________________________________ 2. W ____ ____ ____ ____ ____ ____ ____ ____
last
first
middle
UW Student
ID number
3. Permanent address_____________________________________________________________________ 4. Phone No. __________________________________
5. ____________________________________________________________________________________ 6. Email _______________________________________
city
state
zip
7. Birth date: __________________________________________
8. For which terms are you applying for a scholarship (check all that apply)?
 Fall 2016  Spring 2017
9. Academic status
for Fall 2016:
 Graduate/Professional School  Certification student  Senior  Junior  Sophomore  Freshman  2nd Bachelor’s
for Spring 2017:  Graduate/Professional School  Certification student  Senior  Junior  Sophomore  Freshman  2nd Bachelor’s
Please provide a copy of your letter of admission/acceptance, if you are an undergraduate student; a copy of your letter of admission to a graduate program if you
are a graduate student; or a list of required courses you will take if you are a certification student.
10. If you will enroll for UW credit in off-campus study for Academic Year 2016-17, indicate dates _________________________ to ________________________.
Which program? ____________________________________________________________ Location: ________________________________________________
(for example: Outreach or on-line classes, UW/CC Center, student teaching, student exchange, clinical training, practicums, etc.)
Will you also enroll for credit on campus in Laramie at the same time?  yes  no
11. Degree sought ____________________________________________
How many off-campus credits will you take? ____________________
12. Proposed course of study (major)_______________________________________
13. Indicate the number of semesters you estimate will be necessary for you to complete your degree.
________ semesters
14. Current status (check all that apply):  now attending UW  current Washakie Scholarship recipient  former Washakie Scholarship recipient
15. List all colleges you have previously attended, with dates of attendance and degrees received.
Institution
City/State
Dates attended
Degree(s) received
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
16. Please list the legal dependents under age 18 other than your spouse whom you will be supporting while you are on scholarship.
____________ dependents
FULL NAME
RELATIONSHIP TO YOU
AGE
___________________________________________________________
________________________________________
________________
___________________________________________________________
________________________________________
________________
___________________________________________________________
________________________________________
________________
___________________________________________________________
________________________________________
________________
CWMAC-APP 17
CHIEF WASHAKIE ENDOWMENT SCHOLARSHIP APPLICATION - Page 2
On separate sheets of paper, please answer the following questions. Typed responses are appreciated.
17. Please explain why you selected your academic major, how you plan to use your education after graduation, and what benefit you
think your efforts will be to the Wind River Reservation community.
18. You are not required to be a descendent of Chief Washakie, but if you are, please explain your relationship to him. If you are not a
descendent, please proceed to Question No. 19.
19. Please describe your involvement with the Wind River Reservation community.
20. Please describe any honors you have received, accomplishments you have achieved, and co-curricular and community activities in
which you are involved.
CERTIFICATION: By signing below, I certify that I have read and understand the rules governing the selection process and my
obligations for retention of this scholarship. The information I have provided is true and accurate to the best of my knowledge. I give my
consent to have my application, my transcripts, my test scores, and/or my financial information released to the members of the Committee.
I also give my consent for my name and information in this application to be released as a recipient, if awarded this scholarship.
_________________________________________________________________________________________________
Applicant's signature
_________________________________________________________________________
Date signed
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SCHOLARSHIP APPLICATION CHECKLIST
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Completed application (all applicants)
Free Application for Federal Student Aid (FAFSA) has been submitted (all applicants)
UW letter of Admission (for undergraduates)*
Letter of acceptance to a UW graduate program (for graduate students)*
Documentation of courses required to retain present position (for certification students)*
Statement about your academic major and plans after graduation
Statement about your relationship to Chief Washakie (if applicable)
Statement about your involvement with the Wind River Reservation community
Statement about your honors, accomplishments, and activities
* = if these items were presented with a prior year's application, upon request, they will be attached to this application.
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Return this application and attachments by March 1, 2016, to
Debra Littlesun, Associate Director
Office of Student Financial Aid
Dept. 3335, 1000 E. University Ave.
Laramie, WY 82071
CWMAC-APP 17