ROBERTO GAITAN AND BARBARA PEET
LEADERSHIP CENTER SCHOLARSHIP
2015–2016 APPLICATION
The Roberto Gaitan and Barbara Peet Leadership Center Scholarship was established to provide scholarship support to UT
Arlington and shall be used for the benefit of the Leadership Center in the Division of Student Affairs. Funds distributed
from the endowment shall be used to provide scholarship support to UT Arlington students who have demonstrated
persistent leadership and scholarship in their academic careers. The award is to encourage and recognize their leadership
development and academic achievement during college. PLEASE NOTE: Academic Partnership students and students
opting to participate in the Coordinated Admission Program (CAP) are not eligible for UT Arlington’s general scholarships
or the Maverick Leadership Scholarship.
First Name:
Middle:
UT Arlington Student I.D. Number:
______________ Last Name: _
GPA:
__________
_
Date of Birth:
Mailing Address:
Permanent Address: ____________________________________________________________________
Email Address:
Cell Phone: ___________________________
Minimum Eligibility:
 Open to incoming freshman, transfer and current students of UTA.
 Minimum 1100 SAT or 24 ACT test score or cumulative G.P.A. of 3.25 on 4.0 scale or equivalent
 School transcripts (our office cannot access any transcripts submitted to admissions and records offices, copies must
also be submitted with this application)
 Demonstrate active leadership involvement in a variety of activities throughout high school for incoming freshmen
only and college involvement for transfer and current students.
 Recommendation letter from club or organizational advisor that can address your leadership abilities.
Any individual applying for the Peet-Gaitan Scholarship must have been admitted or currently enrolled in UT Arlington by
Friday, February 13, 2015. The minimum eligibility is the criteria for consideration and not everyone who has met the
criteria will receive a scholarship. Recommendation letters must be in a sealed envelope and submitted with the
application form. Applications are due by 5:00pm on Friday, February 13, 2015.
All materials should be submitted to the:
UT Arlington Leadership Center at:
Attn: Roberto Gaitan and Barbara Peet Scholarship Application
PO Box 19340, Arlington, TX 76019.
You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT
Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas
COMMUNITY COLLEGE/UNIVERSITY ORGANIZATIONAL INVOLVEMENT:
(ALL INFORMATION MUST BE TYPED)
FRESHMAN YEAR
PLEASE LIST ORGANIZATIONS
SOPHOMORE
ORGANIZATION(S)
(PLEASE DESCRIBE BRIEFLY)
POSITION HELD & LENGTH OF
INVOLVEMENT
COLLEGE/ AGENCY
ADVISOR/ SUPERVISOR NAME
CONTACT NUMBER
POSITION HELD & LENGTH
OF INVOLVEMENT
COLLEGE/ AGENCY
ADVISOR/ SUPERVISOR NAME
CONTACT NUMBER
You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT
Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas
JUNIOR
ORGANIZATION(S)
(PLEASE DESCRIBE BRIEFLY)
POSITION HELD & LENGTH
OF INVOLVEMENT
COLLEGE/ AGENCY
ADVISOR/ SUPERVISOR NAME
CONTACT NUMBER
SENIOR
ORGANIZATION(S)
(PLEASE DESCRIBE BRIEFLY)
POSITION HELD & LENGTH
OF INVOLVEMENT
COLLEGE/ AGENCY
ADVISOR/ SUPERVISOR NAME
CONTACT NUMBER
You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT
Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas
COMMUNITY SERVICE/VOLUNTEER ACTIVITIES
PROJECT
(PLEASE DESCRIBE BRIEFLY)
ROLE
DURATION
(# HOURS/DAYS)
ADVISOR/ SUPERVISOR NAME
CONTACT NUMBER
Please list any additional leadership experiences (job, seminars, training, etc) you may have.
What are your plans to continue your leadership development at UT Arlington?
According to state law, students attending post-secondary institutions who are related to a current member of the
University of Texas System Board of Regents are prohibited from receiving scholarships unless the scholarship is
awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B misdemeanor to file a false
statement.
Are you related to a member of the U.T. System Board of Regents? Yes
No
If yes, please circle the most appropriate answer below indicating your relation to any member of the Board of Regents
1.
Regent’s parent, daughter, son.
2.
Regent’s brother, sister, grandparent, grandchild.
3.
Regent’s great-grandparent, great-grandchild, uncle or aunt (brother or sister of parent), nephew or niece
(son or daughter of brother or sister).
4.
Regent’s spouse, spouse’s child, spouse’s parent, child’s spouse, or parent’s spouse.
5.
Regent’s spouse’s brother or sister, spouse’s grandparent, spouse’s grandchild, brother or sister’s spouse,
Grandparent’s spouse or grandchild’s spouse.
Individuals who receive the Peet-Gaitan Scholarship will be recognized at UT Arlington’s Leadership Recognition
Ceremony in April 21, 2015.
You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT
Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas