Southern Illinois University Carbondale

Scholarship Application for Freshmen and Transfer MCMA Students

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

Student Information
Name
Student 850 # if known
or full middle name
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+)
ACT or SAT score

High School GPA or Transfer 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
Academic awards and
accomplishments:

Leadership Activities
List all 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 source.
Family Income (approx. figure) $________________/year
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 an appropriate news releases, including to the following newspaper:

Newspaper name and address:

________________________________________________________________

Your signature: ______________________________________________

Date: _____________________