University of Washington
Office for Minority Affairs and Diversity
Educational Opportunity Program (EOP)
Endowed Scholarship Application
2011-2012
Deadline:
December 14, 2011
5:00 PM
Return to:
Dr. Gabriel Gallardo
Office for Minority Affairs& Diversity
173K Mary Gates Hall, Box 352803
Seattle, WA 98195-3803
Instructions:
Please complete the following application ( only typed applications will be considered). Do not shorten your answer to fit the
allotted space; additional space may be used in another sheet of paper. Only complete applications will be processed,
and must include the following:
1. Application form
2. Copies of transcripts from other colleges/universities attended
3. One letter of reference (mandatory)
Name ___________________________________________________________ Student Number ___________________
Last
First
MI
Local Address _______________________________________________________________________________________
Number
Street
Apt.
City
State
ZIP
Telephone ________________________________
E-Mail Address __________________________________________
Official UW Major (s) & Minor (s) ________________________________________________________________________
Expected graduation date (quarter)? ________________________
Transfer GPA _________
UW Cumulative Grade Point Average ____________
High School Attended ______________________________________________________
Involvement with OMA&D Programs—Please check program (s) in which you have participated through the Office of
Minority Affairs & Diversity in middle or high school, or as a current UW student
GEAR UP___
Upward Bound___
EOP Counseling ___
Student Support Services ___
Ethnic Cultural Center ___
Diversity Scholars ___
Talent Search___
Early Scholars Outreach Program___
Instructional Center ___
EIP ___
STP___
McNair ___
Health Sciences Center Minority Students Program (including IMSD and STAR) ___
Washington Achievers ___ College Assistance Migrant Program ___
If selected as an EOP Endowed Scholarship recipient, I will attend the Celebration Banquet on the evening of May 10, 2012.
I understand that I MAY be delivering remarks (2 minutes) at Celebration and agree to prepare my remarks in collaboration
with the representative(s) designated by OMA&D.
I understand and agree to the aforementioned stipulations if awarded as an EOP Endowed Scholarship Award Recipient
____ Yes ____ No
Please provide a response to the following questions (responses can be typed on a separate sheet of paper):
Please describe activities in which you have been involved that relate to your academic work, e.g., internships,
undergraduate research projects, co-op work, work study jobs, etc.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Please share your campus, student activities/organization(s), and community involvement. Please also share any additional
scholarships or community awards received during your collegiate career.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
If applicable, please describe your post baccalaureate plans. If you do not plan to enter an advanced degree program
immediately following graduation, please describe your career plans.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Please describe any plans you have to do community/human service work and describe the population (i.e., at-risk,
underserved, underrepresented) and issues faced by that community.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
What are your 2011-2012 academic year financial resources, e.g., financial aid, work, loans, additional scholarships,
stipends, and spouse’s income? Describe the extent to which you will depend on these resources and if and how you
supplement your financial aid. If applicable, please include any dependents?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
If you have achieved a good academic record at the UW while coping with serious personal hardship(s), please describe the
obstacle(s) or hardship(s) that you have overcome.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
If there are any additional comments that might be useful in evaluating your qualifications for this academic scholarship
please expound.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
TO BE CONSIDERED FOR ADDITIONAL EOP/OMA&D SCHOLARSHIPS, PLEASE ANSWER THE FOLLOWING QUESTIONS:
Are you interested in participating in study abroad opportunities?
YES ____ NO _____
Do you have an interest in conducting undergraduate research?
YES ____ NO _____
Do you have an interest in studying issues with a focus on the environment?
YES ____ NO _____
I certify that all the information I have provided for this scholarship review is true and accurate to the best of my knowledge.
_______________________________________________
______________________
Signature
Date