Southern Illinois University Carbondale

Scholarship Application for Continuing MCMA Students

Please type or print in black ink and return to your Academic Advisor. Due: January 30, 2009.

Student Information
Name

Student 850 #
Permanent/Home
Address (street
address, city, state, zip)
Local Address (street
address, city, state, zip)
Permanent/Home:
Phone #
Local / cell:
County

E-mail address

Academic Record
In Fall 2009 I will be a (circle) Freshman Soph. Jr. Sr.
Credits: (0-25) (26-55) (56-85) (86+)
GPA (overall)
Major GPA
Major & Specialization (check one):

 MCMA Undecided
Cinema & Photography:
 Cinema
 Photography
Journalism:
 Advertising/IMC
 News/Editorial
 Photojournalism
Radio-Television:
 News
 Sales/Management
 Audio Production
 Video Production

1
List all post-high school academic awards and accomplishments.

Leadership Activities
List all post high school co-curricular activities. Include the number of years you
participated and the offices you held or awards you received. Please be sure to
include all activities, especially those related to your major, such as competitions,
conferences, or festivals in which you participated.
Years in
Activity Offices Held/Awards
Activity

Work Experience and Career Goals

List any jobs, paid or volunteer, you have had in the past three years, including
part-time, student work, internships, community service, etc.
Position Years City Employer

Describe your career plans as specifically as possible:

2
Financial Need Supplement
Dollar amount of school paid by $
parents or other.
Family Income (approx. figure) $________________/year
Number of persons in family
Number of children in college
Employment you now have or plan to
have to help with finances

Salary per month $ /month

Outline any special financial needs in detail.

Applicant Agreement

In connection with this application, I grant members of the faculty and staff of the
College of Mass Communication and Media Arts permission to review my
personal and academic records. My waiver of legal privacy extends only to those
reviews necessary and proper in connection with the consideration of my
scholarship application. I hereby attest as the recipient of a scholarship, I
authorize appropriate news releases, including to the following newspaper:

Newspaper name and address:

________________________________________________________________

Your signature: ______________________________________________

Date: _____________________