A.
COLVILLE
2007
Applicant Qualifications:
The applicant must reside in the State of
The applicant must have completed all undergraduate courses
and hold an undergraduate degree from an accredited college or university. The applicant must be pursuing a graduate
degree in nursing or health services for children. The scholarship applicant must attend a
college/university within the State of
The scholarship will be paid to the applicants
credit at the college/university financial aid office.
An official letter of admissions to the graduate program
from the college/university to be attended must accompany the
application form.
An official college/university transcript must be
sent to the scholarship administrator at the end of each semester in order to
receive support for the next semester.
The A. COLVILLE WILSON SCHOLARSHIP will be awarded at the discretion
of the Board of Directors of the Illinois Masonic Scottish Rite Scholarship
Fund in conjunction with the recommendation of the Scholarship Committee.
This scholarship will be awarded without regard to sex,
race, religion, age or handicap.
Completed application, admission letter, official
transcript(s), and letters of recommendation should be sent to: Application due by May 1
Richard E. Yena, Administrator
A.
Colville
(708)579-5651
email:reyena@sbcglobal.net
2007
A. COLVILLE
Name__________________________________________________
(Last) (First) (Middle)
Home Address___________________________________________________________
(Street)
________________________________________________________________________
(City) (State) (Zip code)
Phone Number___________________________________________________________
Father’s Name__________________________ Mother’s Name___________________
Occupation_____________________________ Occupation______________________
Annual Income__________________________ Annual Income___________________
Number of Dependents in Family____________
Name of
Spouse__________________________________________________________
Occupation________________________________ Annual
Income________________
Please indicate your
anticipated income and expenses for the time it will take you to earn your
graduate degree.
INCOME Yr.1 Yr 2 EXPENSES Yr 1 Yr 2
Savings _______________________ Tuition & Books ____________________
Employment _______________________ Room _____________________________
Loans _____________________________ Meals ______________________________
Family ____________________________ Clothing ___________________________
Other Scholarships __________________ Other ______________________________
TOTAL
__________________________ TOTAL ____________________________
ACADEMIC PREPARATION
College to be Attended for Graduate Degree:_______________________________________________________
Address of College:_____________________________________________
Major Field of Study:____________________________________________
Minor Field of Study:____________________________________________
Degree(s) earned to date:_________________________________________
Grade Point Average:______________
Academic Honors:_______________________________________________
Other Honors Achieved:
____________________________________________________________________________________________________________________________________
Positions Appointed or
Elected:____________________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
Place of Employment:_______________________________________________________
Employer’s Name
___________________________________________________
Employer’s Address_________________________________________________
Type of
Employment______________________ Term of Employment_________
Duties_______________________________________________________________________________________________________________________________
(Additional information may
be added on a separate sheet(s))
2007
If there are circumstances
not covered by this form that you want the Scholarship Committee of the A.
Colville Wilson Fund to consider in processing this application please describe
them below:
References: Please submit three(3)
references. Two (2) references must be
from professors knowledgeable of your academic abilities and one (1) must be a
personal/character reference from a person who knows you personally.
I authorize the school in
which I am enrolled in during the 2006-2007 academic year to disclose to the
Scholarship Administrator of the A. Colville Wilson Fund any and all matters
pertaining to my financial situation, aid and grades.
______________________ ______________________________
(Date)
(Signature)