CONTACT INFORMATION

First Name:
Last Name:
Home Phone:
Alternate Phone:
E-mail:
Address:

ACADEMIC INFORMATION

Cumulative GPA
ACT/SAT Score
Class Rank	out of (enter zeros in each field if you do not know your class rank)

PLEASE ANSWER THE FOLLOWING

1. Briefly list all academic awards/achievements you received while in high school:
2. Briefly list all extracurricular activities/sports you participated in while in high school:
3. Please briefly explain why you chose to attend Southeast Missouri State University:
4. Explain why you feel you are deserving of this scholarship. Be as open and honest as you feel is necessary:
5.(optional) If you feel it is necessary to provide additional information, please do so below:

UNDERSTANDING AGREEMENT

I understand that by applying for this scholarship in no way requires me to affiliate with or join Sigma Nu Fraternity. I understand that by filling this scholarship application out and submitting it I am applying only for the scholarship and not admission into Sigma Nu Fraternity at Southeast Missouri State University.