Division of Student Affairs
Dorman G. Stout, Jr. Student Leadership Endowment
The Division of Student Affairs will be offering a $1,000 Scholarship in honor of Dr. Dorman G.
Stout. The 2011-2012 scholarship will be presented at the Summit Awards on April 12, 2012 at
5:00 p.m. The scholarship is open to any student who will be enrolled at ETSU during the entire
2012-2013 school year. The student to be recognized will be active in leadership within
organizations both on campus and within the community at large.
The award is named in honor of former SGA advisor, Dr. Dorman G. Stout, Vice President for
Student Affairs, Emeritus. Dr. Stout advised the SGA for over 30 years and was himself a
member of SGA. His dedication to East Tennessee State University and its students was evident
every day. The student honored with this award is one who exemplifies the tradition set in place
by Dorman G. Stout.
Applications are available in the Student Affairs Office or on-line at and are due to the SORC
office by 4:30 p.m. on March 12, 2012.
**Award Recipient must attend ETSU for the 2012-2013 school year to obtain the scholarship**
Each applicant must:
1. Be active in student leadership roles in organizations, or in the case of incoming
freshman or transfer students, intend to become active in these student leadership
organizations through the Division of Student Affairs, including but not limited to, the
Student Government Association, Residence Hall Association, POLO, Black Affairs,
Buctainment, Greek Life, Community Service Programs and others as may be established
from time to time in the Division; and
2. Demonstrate the leadership traits and a character of integrity represented by the life and
service of Dr. Stout to East Tennessee State University and humankind.
Please Return Completed Application to the Student Organization Resource Center
First Floor, Suite A, Culp Center
Deadline – Monday, March 12, 2012
4:30 p.m.
All materials must be received by the deadline in order to be considered for the award.
Incomplete applications will not be considered.
Division of Student Affairs
Dorman G. Stout, Jr. Student Leadership Endowment
Please Type or Print Legibly
Name: _______________________________________________________________________________________
Local Address: ________________________________________________________________________________
Local Phone Number: ________________________________ Email Address: ______________________________
Campus PO Box: ____________________________________ Student E#: ________________________________
On a separate page please answer the following questions:
1) List all organizations at ETSU that you are/were ACTIVE in. Give full name of organization, length of
involvement, your accomplishments in the organization and any leadership positions you held along with the dates
they were held.
2) List all community groups in which you were/are ACTIVE. Give the full name of the organization, length of
involvement, your goals and accomplishments in the organization, any leadership positions you held along with the
dates they were held.
3) List two faculty/staff members who could be contacted for a recommendation.
4) In 500 words or less describe how your leadership abilities have developed in your work with ETSU student
organizations and through community development.
Attach this document to your application when you submit it.
Please Return Completed Application to the Student Organization Resource Center
First Floor, Suite A, Culp Center
Deadline – Monday, March 12, 2012
4:30 p.m.
All materials must be received by the deadline in order to be considered for the award.
Incomplete applications will not be considered.