2014-2015 General Scholarship Application

2014-2015 General Scholarship Application
Please read the application carefully and answer all applicable fields before submitting. Failure to complete the form thoroughly or not
providing required items in a timely manner will result in a rejected application. Application must be submitted by the deadline specified.
Note: This application will be submitted for all applicable UTB General Scholarships. If you submit more than one application,
your last application will be the one to be reviewed.
To the extent provided by applicable law, no person shall be excluded from participation in, denied the benefit of, or be subject to
discrimination under any program or activity sponsored or conducted by The University of Texas System or any of its component
institutions on the basis of sex, race, color, national origin, religion, disability, age, or veteran status.
Full Name:
UTB ID#:
Email:
Daytime Phone:
Mailing Address:
Citizenship:
U.S. Citizen
Non-citizen
Permanent Resident
Are you a Texas Resident?
Yes
No
Academic Information
Current Classification:
Freshman (1-29 hrs)
Sophomore (30-59 hrs)
Major Field of Study:
Junior (60-89 hrs)
Senior (90+ hrs)
Minor Field of Study:
Cumulative GPA:
Are you currently employed?
Yes
No
If so, how many hours per week do you work?
Have you volunteered your time towards community service?
Yes
No
Graduate
If so, list school and community activities in which you have participated in the last two years (e.g., student government,
athletics, clubs, organizations, charity groups, church, hospitals, etc.)
Activity/Organization
Hours
Personal Statement
Provide a typed one or two page personal statement to the Scholarship Committee. The statement should include an
organized brief history of your background, educational and career goals, and any your community service and or
volunteer work you have done. Being as specific as possible will assist the committee in the selection process.
Nepotism Statement
State law requires that each student identify any relation to a current Board of Regents member or Board of Trustees
member. A student who is related to a current member of the University of Texas Regents is prohibited from receiving
scholarships unless the scholarship is awarded exclusively based on academic merit or is an athletic scholarship. It is a
Class B misdemeanor to file a false statement.
Please review a list of current members of The University of Texas System Board of Regents at
http://www.utsystem.edu/board-of-regents/current-regents and then select the most appropriate answer below indicating
your relation to any of the UT System Board of Regents.
Not related to a UT System Board of Regent member
If related to either a member of The University of Texas System Board of Regents, please check the relationship from the
following list:
UT System Board of Regents’ mother, father, daughter or son
UT System Board of Regents’ brother, sister, grandparent or grandchild
UT System Board of Regents’ great-grandchild, uncle (brother of parent), aunt,
sister of parent), nephew (son of brother or sister), or niece (daughter of brother or sister)
UT System Board of Regents’ spouse; spouse's child; spouse's mother or father;
child's spouse; or parent's spouse
UT System Board of Regents’ spouse's brother or sister; spouse's grandparent;
spouse's grandchild; brother or sister's spouse; grandparent's spouse; or grandchild's spouse
Certification Release and Signature
I certify that the information given is true and correct to the best of my knowledge and allow the Financial Aid Office at The
University of Texas at Brownsville to release any of the information to the individual(s) selecting or given the scholarship,
upon their request.
Signature
____________________________________
Date
___________________________
Scholarship application should be
returned to:
Office of Financial Assistance
Attn: Irene Cardenas
Enrollment Center @ The Tower
One West University Boulevard
Brownsville, Texas 78520
PH: (956) 882-8277