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Grant/Scholarship Applications from the Department of Curriculum,
Instruction, and Special Education
If a Southern Miss student, you must attach a current SMART sheet.
Return completed forms before April 1, with required
attachments via registered mail to Department of Curriculum, Instruction,
and Special Education, The University of Southern Mississippi, 118
College Drive #5057, Hattiesburg, MS 39406-0001 or via hand delivery
to the departmental office in SRS 143. Late applications or
those with information omitted cannot be considered.
______________________________________________________________________
Identifying and Contact Information
Name ____________________________________________________
Empl ID if Southern Miss student _____________
Street Address ________________________________________
State______ ZIP Code_____________ County__________
Home Phone __________________ Work Phone __________________
E-mail ______________ Campus Phone_____________
Birthplace _____________ (County) _____________ (State)
Current high school or college enrollment_____________________________
Major and Emphasis Area __________________________
Credit hours completed by end of current academic year___
Have you submitted an application to Financial Aid? Yes
No (circle one)
______________________________________________________________________
Academic Qualifications
GPA (program, if applicable)________ (overall)_______ ACT Science
Reasoning_______ English_______ Reading_______ Math_______ Composite_______.
Praxis I Reading_______Writing_______ Mathematics________
Achievements
Please describe important academic accomplishments and honors/awards.
______________________________________________________________________
College/Community Activities/Achievements
Please describe important accomplishments and honors/awards.
______________________________________________________________________
Recommendations: List the names, positions,
addresses, and phone numbers of at least two persons who have written
letters of recommendation for you. Each letter must be in a sealed
envelope with the signature of the person writing the letter written
over the seal. These letters must be included with this form
when submitted.
Name_____________________________ Position ____________________ Address__________________________________
Phone______________________
Why did you choose this individual for a recommendation?
Name_____________________________ Position ____________________ Address__________________________________
Phone______________________
Why did you choose this individual for a recommendation?
______________________________________________________________________
Semester(s) Scholarship(s) Needed:
Summer ___________ Fall ___________ Spring ___________
Please list the titles–exactly as listed in the undergraduate
bulletin--of up to 10 scholarships for which you wish to be considered.
Only list the scholarships for which you meet the criteria
as described in the bulletin.
______________________________________________________________________
Please write a brief autobiography. Include
your career plans as well as an explanation of how you meet criteria
specific to particular scholarships for which you want to be considered.
An extra page may be attached if needed.
