Current Mailing Address: ______________________________________________



Telephone Number (       )                                             Date of Birth ____________________                                                 


Social Security Number                                               Marital Status:  M                S______                     


Number and age of Dependents:                                                                                                       


How Many Dependents Reside With You:                                                                                      


Wyoming Resident  Yes      No              United States Citizen  Yes       No           Gender               


Current Class Standing  (circle one) Freshman/   Sophomore  /  Junior/    Senior /   Graduate                                                                                                       

Major                                                                     Cumulative G.P.A.:                                         


List Extracurricular Activities:                                                                                                         




I certify that the information furnished on this application is true, accurate, and complete to the best of my knowledge and that the University of Wyoming is authorized to verify this information as necessary.


By signing below, I certify that I have read and understand the statements above.


Signature                                                                                              Date_______________                                    


Send the application package to: Adult Student Center, Scholarship Selection Committee, Dept. 3625, 1000 E. University Ave, University of Wyoming 82071. (307) 766-6258


Application deadline is 5:00 p.m. February 16, 2005.


The Adult Student Center is a project within the Dean of Students Office, a unit of University of Wyoming Student Affairs.







Eligibility Criteria:  Applicant must be a University of Wyoming adult student (25 years of age or older) who has completed at least 6 credit hours during the previous fall semester at the University of Wyoming, and has a cumulative G.P.A. of 2.5 or higher.  Applicants must be a United States citizen or a permanent resident.


Selection Criteria:  Scholarship selection will be based on: scholastic achievement and potential; financial need; personal statement; and two letters of recommendation.


Amount of Awards:  The Adult Student Center will award two scholarships each spring semester.  Selected students receive the award for one semester only, but may re-apply for the following year.  The amount of the scholarships for Spring 2005 is $275.00 each.


Application Procedures:


1. Application deadline is February 16, 2005; all application materials must be submitted to the Adult Student Center by 5 p.m. on that date.


2.  Two letters of reference from individuals outside of the Dean of Students Office must be included.


3. Applicant must submit a one page typed personal statement that outlines current circumstances and future goals and aspirations.


4.  The Adult Student Center will verify registration and financial need through the appropriate UW offices (see disclosure statement on application form).


5.  It is the applicant's responsibility to see that all required materials are complete and submitted by the deadline.  Incomplete or late applications will not be considered.