WYOMING ASSOCIATION
OF PUBLIC ACCOUNTANTS
SCHOLARSHIP
APPLICATION FUND
For Wyoming Students Enrolled in the Pursuit of Accounting Education.
MICHAEL LIESCH, VP
JARVIS WINDOM
P O BOX 25
1064 GILCHRIST ST
THERMOPOLIS, WY 82443
WHEATLAND, WY 82201
307-864-2888
307-322-3433
IMPORTANT:
Name in Full:
_______________________________________________________________________________________
FIRST
MIDDLE
LAST
Present Address:
_____________________________________________________________________________________
STREET
CITY
STATE ZIP
PHONE
Permanent Address:
__________________________________________________________________________________
STREET
CITY
STATE ZIP
PHONE
U.S. Citizen: _____Yes
_____No State of
Wyoming Resident: ______________________________________________
Length of residency in
Wyoming: ____________ years
Marital status:
_____Single
_____Married
_____Separated
_____Divorced
_____Widowed
Ages of children (if any):
_______________________________________________________
If married, Name of Spouse:
___________________________________________________________
Spouse’s Occupation:
________________________________________________________________
Professional field you plan
to enter: _____________________________________________________
Name and Address of the
College, Community College or University you plan to attend:
Name:_____________________________________________________________________________
Address:___________________________________________________________________________
Degree to be received:
________________________________________________________________
Date you plan to attend:
From ____________ to ___________ (Mo/Yr)
Have you applied for
admission to the school? __________YES
__________NO
Have you been accepted?
__________YES __________NO
(PLEASE SEND US A COPY OF YOUR LETTER OF ACCEPTANCE.)
Are you an existing student
at the school? __________YES
__________NO
List High School from which
you graduated and Colleges you have attended:
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Name of School |
City & State |
From - To |
Major Field |
Degree Earned |
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High School |
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College |
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Please enclose your transcripts from high school and college. If a transcript is unavailable by the ____________ deadline for applications,
mail your application by
the deadline without the transcript but tell us when the
transcript will be available.
Explain and unusual circumstances regarding your financial status in the following space. It may be to your advantage,
for instance, for the committee to know your
family size or special needs.
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Employer and Job
Description
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Full/Part-time |
Dates of
Employment |
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REFERENCES.
When you supply information
requested below, you are giving the committee permission to contact your
references.
PERSONAL CHARACTER REFERENCE
NAME:
____________________________________________
PHONE: _____________________
ADDRESS:
________________________________________________________________________
Street
City
State
Zip
PROFESSIONAL REFERENCE:
NAME:
____________________________________________
PHONE: _____________________
ADDRESS:
________________________________________________________________________
Street
City
State
Zip
PRINT a brief paragraph giving your reasons for wishing to study in the professional field of accounting.
(Example:
When did you first become interested?
What opportunities have you had to observe the practice of the
profession?)
If your previous education
has been interrupted because of illness, employment, finances, travel, etc.,
please explain:
Because competition for awards may be very great, in the question below it will be to your advantage to clarify the
need for financial
assistance as completely as possible:
Projected School Costs:
Your school year is _____Months _____Quarters _____Semesters ______Tuition $_______________
Food & Housing $_______________ Personal $______________ Books & Supplies $_______________
ransportation
$_______________ Other personal
$_______________ (Daycare, monthly payments, insurance)
Your sources of
financial support:
|
SOURCE |
Approximate annual
income of source, if
applicable |
Estimate amount of
support in dollars you will receive from this source |
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Parent or Guardian |
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Spouse |
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Self |
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Others (Financial
Aid, Social Security, other scholarships, etc) |
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Areas of your special
interest and proven leadership ability:
List of other scholarships
for which you have received or will receive.
If I am granted a scholarship, it is my intention to complete the educational program outlined
I agree to inform the Wyoming Association of Public Accountants Scholarship Fund immediately if
I am no longer interested in preparing for the profession indicated or if my plans change. I also agree for WAPA
to publish my name and awards in their material.
I agree that this application and all credentials submitted by me or others on my behalf will remain the property
of the Wyoming Association of Public Accountants Scholarship fund.
____________________
_______________________________________________________
Date
Signature of Applicant