OCCUPATIONAL THERAPY FACULTY ENDOWED SCHOLARSHIP APPLICATION EASTERN KENTUCKY UNIVERSITY DEPARTMENT OF OCCUPATIONAL SCIENCE AND OCCUPATIONAL APPLICANT INFORMATION Name: EKU Student ID Number: Local Phone: Local address: City: State: ZIP Code: State: ZIP Code: Permanent address: City: E-mail: Other Phone: Applicant Signature: Date of Application: SCHOLARSHIP CRITERIA Criteria: Planned entry into year one of the EKU, Master of Science in Occupational Therapy Program Min GPA of 3.00 Resume demonstrating the potential for successful Occupational Therapy practice Narrative (descriptive) list of professional goals 1-2 page essay, typed and double spaced, outlining need for scholarship Completed Student Aid Report (SAR) (summary of rated FAFSA) demonstrating financial need SUBMIT ALL APPLICATION MATERIALS TO THE PEGGY BOWMAN IN DIZNEY 103 BY THE DEADLINE DATE FOR OFFICE USE ONLY Application Form Complete: YES Essay Attached: Resume Attached: YES YES NO NO GPA: NO Professional Goals Attached: YES Interim Revision 1/07, 4/09 Date Received: FAFSA Attached: NO YES NO