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Name
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Address
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Phone Number
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Email
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SHAPE MICHIGAN MEMBER
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Major(s)
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Minor(s)
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Current Class Standing
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Overall GPA
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I am enrolled in at least 12 credits as an undergraduate or 6 credits as a graduate student
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I will be enrolled in at least 12 credits undergraduate or 6 credits grad work in Fall 2018
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A essay of no more than five (5) typed pages (double-spaced & 12 point font) that discusses your future goals, extracurricular activity, community service, professional development, and leadership opportunities.
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I Plan on Attending the Awards Dinner (October 27th , Lansing, MI)
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I agree to submit to exec@shapemichigan.org a typed final report of 1-3 pages to the Scholarship Committee, no later than the annual convention of the following year after acceptance of the Scholarship funds, describing the extent to which the scholarship aided in my professional preparation.
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Two (2) letters of support from your college/university advisor and/or other professors or supervisors familiar with your academic work, extracurricular activity, community service, professional development, and leadership work. These letters are to be sealed in an envelope Roger S. Jackson Executive Director/C.O.O.SHAPE Michigan PO Box 27187 Lansing, Mi 48909
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APPLICANT SIGNATURE By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
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