APPLICATION
SDX Foundation of Washington, DC
Sigma Delta Chi Journalism Scholarships
DEADLINE: March 15, 2012
Responses must be typed and the form must be completed and signed. Use extra sheets of paper as needed for longer responses.
1. Name: Mr./Ms.____________________
2. Birth date: ______________________
3. Social Security #: __________________
4. University:____________________________________________
5. Local Address
(street):_____________________________(city):_________
(state)_________ (zip)__________
6. Phone: (day) _____________________ (evening) ______________
7. E-mail address(s): _______________________________________
8. Parents’ (name/names):___________________________________
(street):_____________________________(city):________________
(state)_________ (zip)__________ (phone)_____________________
9. Address and phone after school ends, early June and summer (in case SDX needs to contact you):
(street):__________________________________(city):____________
(state)_________ (zip)__________ (phone)_______________________
10. I will be a JUNIOR or SENIOR (circle one) next academic year, which will be: _______
11. My major is: ______________________________and my minor is _______________
12. GPA: _______________ NOTE: Please include with this application a verified copy of your up-to-date academic transcript containing grade point average for classes taken since entering as a freshman.
13. Tuition for next academic year* (year total): $______________Room/board: ______________
Other expenses (est.): $_________________
Brief explanation (include semester abroad, if applicable):
_____________________________________________________________________________
______________________________________________________________________________
TOTAL expenses for next academic year:$_____________.
*Academic year means fall and spring semesters combined.
14. Income/funds available for next academic year:
Earnings: $______________
Savings: $______________
Loans: $______________
Parents: $______________
Scholarships: $______________
Awards: $______________
Other: $______________
TOTAL: $______________
NOTE: If you are selected as one of the winners, the scholarship may affect your grant package (if you receive one) from your school.
15. Current employment:
_________________________________________________________________
Upcoming summer employment:
_________________________________________________________________
After graduation:
_________________________________________________________________
Please answer the following questions on a typed separate sheet of paper, responding in a brief narrative.
16. How are you paying for your education this academic year? Please provide details, including all sources of income.
17. If you do not receive this scholarship, how will you pay for your education?
Use this space to list sources of income (including wages, scholarships and loans)
Answer all of the following questions. Please choose one to answer in greater detail than the others. Please circle your choice.
18. Please tell us about your journalist activities and accomplishments. What are you proudest of? Why? What were you least satisfied with? Why?
19. I believe I am a worthy applicant for this award because:
20. In five years, professionally, I want to have achieved…
In ten years, I want to have achieved….
21. To me, the First Amendment of the U.S. Constitution means …
22. Please provide the name, title, address and phone number of the faculty member you asked to provide a letter of support/endorsement. The faculty letter must be postmarked by December 20, 2010 and mailed directly from that faculty member to the below address.
______________________________________________________________________________
_____________________________________________________________________________
Phone: ________________________________
If you are selected as a finalist you will be contacted for an interview by the scholarship committee. Winners will be announced at the beginning of May, 2012.
Your signature below indicates you have read the guidelines regarding the SDX Foundation DC scholarships and believe you are eligible for an award. Your signature also indicates all statements in your applications are true, accurate and complete, to the best of your knowledge.
CHECKLIST: 1. This form. 2. Up to six (6) samples of your journalistic work (materials submitted may not be returned). 3. A complete transcript mailed by your school. 4. A letter of endorsement from a college teacher or advisor.
All mailed items must be postmarked by March 15, 2012. Send to:
Scholarship Committee
SDX Foundation of Washington, D.C.
P. O. Box 19555
Washington, DC 20036
All emailed items must be received by March 15, 2012. Send to:
Put your name in the subject line
If you include links it is your responsibility to make sure the links function.
Signature: ____________________________Date:______________
Sigma Delta Chi DC 