School of Communication
SCHOLARSHIP APPLICATION FORM FOR
ACADEMIC YEAR 2011-2012
APPLICATION DEADLINE – FEBRUARY 1, 2011
Before completing this application, please refer to the scholarship brochure available from the School of Communication
office or meet with your advisor to determine scholarship(s) for which you are eligible. This application form can be used to
apply for any School of Communication scholarships for which you are eligible on this one application, but you must check
all scholarships for which you are applying. A complete application consists of the following:
1.) a completed School of Communication Scholarship application.
2.) a completed transcript or LOUIE printout of all college work, or if you are an entering freshman, your most recent
high school transcript, and
3.) any other support material required by a specific scholarship.
Student’s Name: ___________________________________________________________________
Last
First
M.I..
Local Mailing: ____________________________________________________________________
Number/Street
Apt. No.
___________________________________________________________________
City
State
Zip Code
Telephone: (Local) _____________________________ Student ID Number _________________
(Home/Parents) _____________________________
(Cell) ________________
Email Address: _________________________________________________________________
Enrollment Status: (check one) _____ Continuing Student _____ Incoming Freshman _____ Transfer Student
Hours Completed ________
Hours in Progress________
Cumulative GPA ________
Check your Major Status:
_____ Not a School of Communication Major _____ Major in the School of Communication
Check the program in Communication that is your Major and supply Program or Emphasis area:
_____Advertising
_____ Merchandising
_____ Speech Communication
_____Electronic Media & Film
_____ Photography
_____ Visual Communication
_____Journalism
_____ Public Relations
Program Emphasis ______________________________________ Minor ____________________________
Check all Scholarships for which you are applying:
_____ School of Communication Alumni Scholarship
Advertising
_____ Duncan Jennings Memorial Scholarship
_____ Scripps Advertising
_____ Scripps Journalism
Rev: 2/17/2016
Electronic Media & Film
_____ Arizona Broadcasters Association
_____ Bruce Wayne Dyer Memorial
_____ Eric & Myrene Temple
_____ Bill Close Broadcast Journalism
_____ Sandusky/K-JACK Radio
Journalism
_____ Guy C. Brown Memorial
_____ Robert B. Larson
_____ Jan Stevens Lifestyles Journalism
_____ Mason Walsh Memorial
_____ Scripps Photojournalism
_____ Scripps Journalism
_____ Melvin T. Hutchinson Memorial
_____ Wylie Smith Sports Journalism
_____ Reader’s Digest Feature Writing
_____ Scripps News Editorial
_____ Scripps Environmental
_____ Scripps Recruiting
Merchandising
_____ Merchandising Leader of the 21st Century
_____ Moller Merchandising Scholarship
Photography
_____ Mariah Dunleavy Memorial
_____ Scripps Photojournalism
_____ Moller Photography Scholarship
_____ Scripps Journalism
Public Relations
_____ Scripps Public Relations
_____ Scripps Journalism
Speech Communication
_____ Harold C. Larson Speech or Pre-Law
_____ Klonda Lynn Speech
Visual Communication
_____ Mary E. Bayless Visual Communication
_____ Moller Visual Communication
Student Letter - Please type an explanation of why you want/need the scholarship(s) for which you are applying.
Include a list of scholarships and other financial aid you are now receiving as well as those you anticipate
receiving next year with the amount of each award. Then, list in reverse chronological order (most recent to least
recent) high school or college clubs and organizations with which you have been involved. Include honors,
offices/positions held, responsibilities taken on, etc. Finally, type a 200-250 word statement in response to the
question: “What effect would you want your career to have on your communication field?” Please type all
application materials neatly and follow appropriate writing standards and style. Remember to attach a transcript or
LOUIE printout of all college work.
ALL APPLICANTS: By signing below, it is understood and consent is given to release academic, financial or
any other information as required by NAU or by the donor. By signing below, I certify that the information on
this form is complete and true.
____________________________________________
Applicant’s Signature
________________________________
Date
Submit your application to the School of Communication office between November 29, 2010 and 5 p.m. Monday,
Feb. 1, 2011 or mail to: School of Communication, Northern Arizona University, Box 5619, Flagstaff, AZ 860115619, by February 1, 2011.
Rev: 2/17/2016