GLBT Alumni Council Student Scholarships 2015
The GLBT Alumni Council, in association with the LGBT Campus Center, Division of Student Life, is proud
to award the below scholarships to lesbian, gay, bisexual, transgender, queer, and similarly-identified
individuals and their allies who have shown potential and sustainable leadership and impact on the
GLBTQ community at the University of Wisconsin-Madison. Applicants from across the spectrum of
sexual orientation, gender identity, and/or gender expression are welcome.
Through the commitment and investment of its alumna/ae, the GLBT Alumni Council will award a total of
$4,000 in scholarships for the 2015-2016 academic year. No award shall be less than $300.00.
These scholarships include:
Milo and Virgil’s Fabulous Fund Scholarship
Bayard Rustin Endowed Scholarship Fund
R. Richard Wagner Undergraduate Scholarship
Tracy Woolever Scholarship
Sippel/Bemis Leadership Award
General Eligibility Requirements
Applicants must:
- demonstrate a commitment to LGBTQ communities
- be enrolled 12 or more credits per term or the graduate equivalent
- once awarded, remain in academic good standing for the duration of the scholarship
- be willing to be publicly acknowledged as a recipient of the award
Applicants should download the Scholarship Application .pdf, complete the required fields and return the
completed materials via email to gjavier@studentlife.wisc.edu with “Scholarship 2015” in the subject
line.
Please use the following naming convention when saving your completed .pdf scholarship application
“LNAME_FNAME_App2015” [example: LORDE_AUDRE_App2014][example 2: MINOGUE_KYLIE_App2015]
For full consideration, completed materials should be submitted by Monday, April 27, 12:00 noon CST.
Decisions will be announced no later than Monday, May 4. If chosen as a recipient of a GLBT Alumni
Scholarship, please mark your calendar for Rainbow Graduation, Thursday, May 14, 5:30pm in Memorial
Union Tripp Commons, where scholarship recipients will be recognized.
Questions and completed materials should be emailed to:
Gabe Javier
Assistant Dean of Students
Director, LGBT Campus Center
gabe.javier@wisc.edu
GLBT Alumni Council Scholarships
page 1 of 6
University of Wisconsin-Madison
Section 1- Required Personal Information
Legal First Name
Date of Birth
Preferred First Name
(MM-DD-YYYY)
Middle Initial
Last Name
Student ID Number
Current mailing address
Preferred email contact
Preferred phone contact
If you are originally from the state
of Wisconsin, what county are you
from?
Section 2. Optional Demographic Information
Sexual Orientation
Gender Identity
Race/Ethnicity
First language, if other than English
Parent/Guardian First and Last Name
Parent/Guardian First and Last Name
How would you describe your LGBT outness?
If you would like to provide additional information or points of clarity regarding your sexual orientation, gender identity, or
outness, please do so here.
Is there any special information you would like to share regarding your family or your relationship with your family?
Are there any other special household circumstances that you would like to share (situations of homelessness, foster care,
etc.)?
GLBT Alumni Council Scholarships
page 2 of 6
University of Wisconsin-Madison
Section 3: Current and/or Previous Academic Information
What year in school will you be
during the beginning of the Fall
2015 semester?
Degree sought
Major/area of specialization
Other majors
Certificates or minor fields of study
Previous Educational Experience
University or college previously
attended, and dates attended
Academic major(s) and minor(s)
earned
GPA earned out of 4.0
University or college previously
attended, and dates attended
Academic major(s) and minor(s)
earned
GPA earned out of 4.0
Name of high school you attend or
from which you are graduating
Date of high school entry and date
of graduation/anticipated
graduation
GPA earned out of 4.0
GLBT Alumni Council Scholarships
page 3 of 6
University of Wisconsin-Madison
The following sections (Section 4 and Section 5) may be completed on this form, or applicants may
submit a resume that addresses both sections.
Section 4. Involvement
You have three opportunities to highlight your most significant extra-curricular activities. In this section,
reflect on some of the experiences that have informed and influenced your life thus far, particularly those
experiences related to leadership, identity development, civic engagement, or community service.
Name of experience
Organization
From mm/yy to
mm/yy and hours per
week
Description of experience
and impact it had on you
(200 words or less)
Name of experience
Organization
From mm/yy to
mm/yy and hours per
week
Description of experience
and impact it had on you
(200 words or less)
Name of experience
Organization
From mm/yy to
mm/yy and hours per
week
Description of experience
and impact it had on you
(200 words or less)
GLBT Alumni Council Scholarships
page 4 of 6
University of Wisconsin-Madison
Section 5. Scholarships, Awards and Honors
Please list and briefly describe any other scholarships, awards, or honors that you have received.
Name of
Award/Scholarship
Organization Name
Date awarded
Amount of
monetary award
(if applicable):
Name of
Award/Scholarship
Organization Name
Date awarded
Amount of
monetary award
(if applicable):
Name of
Award/Scholarship
Organization Name
Date awarded
GLBT Alumni Council Scholarships
Amount of
monetary award
(if applicable):
page 5 of 6
University of Wisconsin-Madison
Section 6. Essays
Please complete two of the three following essays. Each essay should not exceed 650 words. Each essay
should be saved as a separate file, following the file naming conventions listed. Acceptable file formats
are .docx and .pdf. Please indicate the question number at the beginning of your essay (Question 1,
Question 2, or Question 3). Do not include your name in the body of the document.
Question 1.
Please describe what you think is the top issue facing LGBTQ college students. What are some of the
systemic roots to this problem and what would you suggest as some solutions?
(please save as “LNAME_FNAME_ESSAYQ1”)
Question 2.
Gender identity, gender expression, and sexual orientation are just some aspects of multiple social
identities. Please discuss an experience where the intersection of your multiple identities has changed or
affected your worldview or how you interact with others.
(please save as “LNAME_FNAME_ESSAYQ2”)
Question 3.
Please discuss how being committed to LGBTQ issues contributes to your understanding of the Wisconsin
Experience.
(please save as “LNAME_FNAME_ESSAYQ3”)
Certification
I understand that my application will be shared with the GLBT Alumni Council’s Scholarship Selection
Committee. In submitting this application, I have been truthful and honest to the best of my knowledge
and understanding. I understand that any deliberate misrepresentation of information will result in
forfeiture of any scholarship(s) received. I certify that all information in my application, including my
essays, is my own work, is complete and accurate, is factually true, and is honestly presented to the best
of my knowledge.
Initials/digital signature
and date
Checklist
Section 1 & 2: Personal and Optional
Demographic Information
Section 3: Previous Academic
Information
Section 4 & 5 OR current resume
Two of three completed essays, each
saved in a different file, named
according to instructions above
Final page: certification statement
For full consideration, all materials must be submitted via email by 12:00 noon, Monday, April 27, 2015.
Completed applications and inquiries may be sent to Gabe Javier at gabe.javier@wisc.edu.
GLBT Alumni Council Scholarships
page 6 of 6
University of Wisconsin-Madison