Name:                                                                                Soc. Sec.#

Local Address:

Local Telephone number:

CLASS STATUS:  To be eligible, a student must have completed 64 hours by the end of the current spring semester with an overall QPA of 3.00.  Students must also have completed 15 hours in Psychology, at least 9 of which must have been earned at Clarion University.

 Total number of hours earned by end of this spring semester:

 Total number of hours earned in Psychology by end of this spring semester:

 Number of hours in Psychology earned at CUP by end of this spring semester:

SCHOLARSHIP:

         QPA in all college courses to date:

         QPA in Psychology:
 

SERVICE TO THE DEPARTMENT:

Membership in:         Psychology         Student Affiliate of American
  Club                        Psychological Association
 
         Psi Chi         Student Affiliate of American
                                                               Psychological Society
 

Offices held and dates of term:
 
 
 
 
 

Involvement in special events promoting Psychology:
 
 
 
 
 
 

RESEARCH PROJECTS:
    Describe research projects in progress or completed.  Identify your research supervisor and
responsibilities.  Please include dates.
 
 
 
 
 
 
 
 

SPECIAL ACADEMIC DISTINCTIONS:
    Describe awards, prizes, scholarships, or recognition earned.  Please include year(s) of awards.
 
 
 
 
 
 
 
 

OTHER RELEVANT INFORMATION:
    Include any other contributions made to Psychology not already listed.
 
 
 
 
 
 
 

REFERENCES:
    I authorize the committee to contact any of my instructors listed below in order to clarify or confirm statements and/or materials supplied by me, in support of my candidacy for the scholarship.  I also authorize the Scholarship Committee to view my transcripts.
 

                                                                                                                      
                           Signature                                                    Date
 

Referee:                                                                       Telephone #:

Referee:                                                                       Telephone #:
 

Please leave your application with the Psychology Department secretary, Rm. 237 Harvey Hall by the last Friday in March.  Attach additional sheets if necessary.  To be eligible for this award, which will be granted in the fall, you must be enrolled as a full-time student at that time.

Page by Psi Chi web group
URL= http://psy1.clarion.edu/jms/endowedschol.html

Last modified January 31, 2002.