Tuition Waiver

 

 

Application for SIUC Graduate Tuition Scholarship Southern Illinois University Carbondale

Purpose: The purpose of the SIUC Graduate Tuition Scholarship as designated designated by the Board of Trustees is to assist students who have attained high levels of academic achievement.  Name________________________  Name_____________ _______________________ ________________________ ___________________ _______ Social Security # ______________ _______________________ _________ Last

First

Middle

Mailing Address ________________________ _____________________________________ _________________________ ___________________ _______ Phone _____________ ______________________ _________  No. and Street

Degree Sought: Citizenship:

City

Masters

Ph.D.

State

Zip

Name of program ________________________ ___________________________________ ______________________ ____________ _

U.S.A. Citizen Permanent Resident of U.S.A.  Non-U.S.A. Citizen

Race (optional):

American Indiana or Alaskan Native Asian or Pacific Islander Black, non-Hispanic Hispanic White, non-Hispanic, other Other

Please check (X) the specific term(s) for which you’re seeking a scholarship: Fall, 20___ Spring, 20___ Summer, 20___ (Note: Award maximum is three semesters, must reapply each semester, does not have to be consecutive) 1. If your undergrad undergraduate uate Grade Point Average Average (GPA) or graduate graduate GPA is low, outline any special special experiences or activities that may have accounted for it.

2. Graduate School attendance at SIUC: Date

Date degree conferred

Masters: Began__________ Began______________________ ________________________ ____________ Program _______________________ _________________________ __ Date

or expected __________ ______________________ ___________________ _______ Date degree conferred

Began_____________________ ________________________ _____________ _ Program ______________________ Doctoral:Began_________ _________________________ ___

or expected ____________ _______________________ _________________  ______  

List below any forms of financial assistance you have received from SIUC (assistantships, fellowships, tuition scholarships, etc.) and the dates of this assistance:

For Graduate School use only: Admitted to program:

Yes

No

Undergraduate GPA ____________ ________________________ ______________ __ Graduate GPA ________________________ ________________________,___________ ,___________ hours Recommended

Denied

 _________________________  ____________ _________________________ __________________ ______  Associate Dean, Graduate School  

______________________ ______________________  Date 

 

3. Please specify any ot other her form of financial financial assistance you you will receive, or employment to be held during tthe he term for which you are applying.

4. Please explain why you feel that you merit merit a tuition tuition scholarship. scholarship.

In order to be eligible for an SIUC Graduate Tuition Scholarship you must complete the following draft registration Compliance statement: DRAFT REGISTRATION COMPLIANCE STATEMENT I certify that I am not required to be registered with Selective Service because: I am female I am in the Armed Services on active duty (note: members of the reserves and the national guard are not considered to be on active duty.) I have not reached my 18 th birthday. I was born before 1960 I am a permanent resident of the Trust Territory of the Pacific Islands or the Northern Mariana Islands. I am an international student (applicable only to State of Illinois funded programs). I am an incarcerated student. I certify that I am registered with Selective Service. I declare under penalty of perjury perjury that the foregoing is ttrue rue and correct. I am fully aware that any intentional intentional falsification of information contained herein may result in the denial of the application or loss of aid currently being received. I realize furthermore that this scholarship will be revoked if I fail to meet the designated requirements of being enrolled in a graduate degree program and carrying 9 hours of graduate credit during the fall and spring semester, 3 hours of graduate credit during the summer session, or if I receive any other type of a tuition scholarship. As an applicant for a tuition or fee waiver award from Southern Illinois Universit University, y, I understand that the University has the legal authority to release my name and address, the name of my former high school or college, the name of my award, and the award amount. This release is valid for the peri period od of time the tuition w waiver aiver is in effect.

Signed______________________ Signed__________ ________________________ _________________________ _________________ ____ Date_________________________ Date__________________________________ _________

Return completed application application to: Karen M. Jennings, Assistant Assistant to the Dean Graduate School MC 4716 Southern Illinois University Carbondale, Illinois 62901-4716 Deadline Dates: FALL SEMESTER – JULY 15 SPRING SEMESTER – NOVEMBER 15 SUMMER SEMESTER – APRIL 15