Scholarship Application

Note: This application is used for both the academic and housing scholarships. You will be contacted with more information several weeks after you apply.

First Name	*
Middle Iniitial
Last Name	*
Sex	MaleFemale*
Street Address	*
Street Address Line 2
City	*
State	*(abbreviate)
Zip/Postal Code	+* (+4 Optional)
Home Phone	--*
Contact Phone	--(If different than home phone)
E-mail	* (Please use your @wisc.edu
	account if you have one)
Intended Major	*
High School	*
High School GPA	*
High School GPA Scale	*(Exampes: 4.0, 5.0, 100... etc)
ACT Score
SAT Score
Father's First Name
Father's Last Name
Mother's First Name
Mother's Last Name

It is recommended that you write your following responses in a word processing program such as Microsoft Word. Then simply copy and paste your repsonses to the corresponding field. Do NOT use any formatting (bold, italics, bulletpoints) as it will not be copied correctly!

Extra-curricular Activities: (clubs, sports, and organizations)

Leadership Roles

Volunteer Work and Job Experience

Awards and Honors

Reasons you feel to be a qualified applicant

Check this box when your application is complete.