University of Utah
College of Health
Richard K. and Maria A. Obyn Memorial Scholarship
Application Deadline: Friday February 15, 2016 by 4:30 pm
Today’s Date: _______________________________________
Mr. /Mrs. /Ms. _________________________________________________ Student I.D. # ______________________________
Home
Address _______________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Telephone Number ___________________________________ Email_____________________________
Declared Major (premajor not accepted) ________________________ Semester hours completed _____________________
Anticipated Graduation Date (semester & year) _____________
Current GPA (listed on DARS) __________________
Other college(s) attended (if
any) __________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Resident of Utah?
Yes
No
If no, state or country of residence
U.S. citizen or legally residing in the U.S.? Y / N
If no, please contact the Assistant Dean for Student Affairs in the College of Health prior to applying.
The following must be included in your application:
1.
2.
3.
4.
5.
6.
7.
A statement no longer than two pages that includes a description of your academic and professional goals, reasons why
you feel you are a strong candidate for this scholarship, how you will increase or impact diversity in the College of Health,
and any financial information that should be considered.
A list of all scholarships and financial aid that you have received while attending the University of Utah.
A list of all other scholarships or sources of financial aid that you are applying for this year
A list of any pertinent scholarly accomplishments, honors, or special awards of recognition you have received.
A description of your community involvement and/or university activities.
A current transcript of your grades (DARS is acceptable if printed as “List - List of Classes”). If you have been at the
University of Utah for less than two semesters, please submit a transcript from other schools attended.
Two letters of recommendation. Letters must be delivered separate from the application and must be signed and sealed,
and the sealed envelope must be signed across the flap with the author’s signature. All letters of recommendation
requests from students must have written permission from the student to release personal information. A release
form is available at:
http://registrar.utah.edu/_pdf/letter-of-rec.pdf
If you have questions about the application, please contact Shari Lindsey, Assistant Dean of Student Affairs, at 801-585-5764 or
visit HPER N 200 for more information.
Application Deadline: Friday, February 15, 2016 by 4:30 pm
Submit the completed application and supporting documents to
The Center for Student Success, HPER North Room 200
Scholarships, Fellowships, or Other Financial Aid
Any student who receives a scholarship, fellowship, or other financial aid administered by the University of Utah is
required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another
country who is lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should
seek the advice of an immigration attorney before filing a scholarship/financial aid application.
Student Citizenship Status (Check one of the following):
o
o
U.S. Citizen
Lawfully Present, Non-Citizen of the U.S.
Prior to the disbursement of any scholarship/financial aid, the University of Utah is required by law to verify with the
Department of Homeland Security (DHS) the lawful presence in the U.S. of students who are not U.S. citizens. Once
the University submits a student’s information to DHS for verification, this federal agency may have the legal right to
share the information with other government agencies.
Print Name Student ID ____________________________________________________________________
By signing this application, I certify under penalty of perjury that I am either a U.S. citizen or a citizen of another
country who is lawfully present in the U.S. I understand that my status and eligibility for financial aid/scholarship
within the U.S. will be verified through the Department of Homeland Security prior to an award of this
scholarship/financial aid.
Applicant Signature ________________________________________________________________________
Contact information for questions or concerns:
John Curl, Director of Financial Aid, jcurl@sa.utah.edu / 581-8788; or
Feleti Matagi, Director of Undergraduate Diversity Scholarships, f.matagi@utah.ed / 581-4378
Scholarship Opportunity
College of Health Richard K. and Maria A. Obyn
Memorial Scholarship
Scholarship Process & Information
1. Two scholarships shall be awarded to outstanding undergraduate students declared in the College of
Health. Recipients of these scholarships shall be known as Richard K. and Maria A. Obyn Memorial
Scholars.
2. Scholarship recipients shall be selected by the Dean of the College of Health and a selection
committee.
3. The scholarship award will be paid in two equal payments per semester over the course of the
academic year.
4. New scholarship recipients will be selected each year.
Scholarship Requirements
1. The scholarship recipient must maintain a minimum of 12 semester hours for two of the three
semesters during the academic year the scholarship is disbursed.
2. The scholarship recipient must have been enrolled a minimum of 12 semester hours for two of the
three semesters prior to the year of application.
3. The scholarship recipient is expected to attend a scholarship luncheon in October.
4. Applicant must be a major within the College of Health. If the scholarship recipient changes majors
within the College of Health, the scholarship will not be affected. If the scholarship recipient changes
majors to a discipline outside the College of Health, s/he forfeits the remainder of the scholarship.
5. Application will be disqualified if not submitted correctly, completely, and timely.
Scholarship Selection Criteria
1. At the request of the donors, preference shall be given to recipients who are African-American or
Native American or of other traditionally under-represented groups pursuant to applicable federal and
state laws and who meet the basic criteria.
2. Distinctive strengths (community service, leadership skills, etc.)
3. A minimum 2.0 GPA
4. A well-written and compelling personal statement
5. Academic success and potential for success
6. A well-prepared application with excellent recommendations.