DENISE I. GRIFFITHS CPAM SCHOLARSHIP APPLICATION

Name _________________________________________

Address _______________________________________

_____________________________________________

Telephone number _______________________________

Social Security Number ____________________________

Birth date _____________________________________

Father's Name __________________________________

Father's Occupation ______________________________

Mother's Name _________________________________

Mother's Occupation _____________________________

Brothers and Sisters (names and ages)

____________________________________________

High School ___________________________________

Telephone Number ______________________________

Address ______________________________________

____________________________________________

Choice of College:
1. __________________________________________

2. __________________________________________

3. __________________________________________

Extracurricular Activities* __________________________

____________________________________________

____________________________________________

____________________________________________

Community Service Activities* _______________________

____________________________________________

____________________________________________

____________________________________________

Awards and Honors* ______________________________

____________________________________________

____________________________________________

____________________________________________

Personal essays:

1. Submit a double-spaced (maximum of two pages) essay addressing one or more of the following points

a. Tell why you want to be a mathematics teacher.
b. Describe any special talent, ability, or skill you possess that will help you become an effective teacher.
c. Describe how one of your teachers has influenced your career goals.

2. Submit a paragraph explaining your need for financial aid.

This application must be accompanied by one copy of your high school transcript through the first semester of the senior year, a school profile, a copy of your scores on the SAT or the ACT, and three letters of recommendation from the Presidential Awardee who nominated you, from another mathematics teacher who has had you in class or worked with you on extracurricular activities, and from a guidance counselor or school administrator.

*Attach additional sheet if necessary

Certification: By my signature, I certify that all of the information given by me on this form is true and complete to the best of my knowledge.

Signature of Applicant _____________________________________________

Date __________________________

Signature of Awardee _____________________________________________

State/Year _____________________________________________

Return to:
Kris A Warloe, Chair
Denise I. Griffiths CPAM Scholarship Committee
1260 NW Lewisburg Ave.
Corvallis, Oregon 97330

DEADLINE: March 1, 2012 | Download Version: Word | PDF