Eligibility for Scholarships Includes:
 Enrollment in at least 9 credits per semester.
 Credits earned through Fall semester 2015 cannot
exceed 120 credits.
Scholarships for amounts over $500 will be divided equally between Fall and
Spring Semester, unless otherwise stated.
Please Read Carefully!!
Please Print
Name: _________________________________________________________________
SSN or Banner ID: ________________________
Current Address: _______________________________________________________
Address
City
State
Zip
Phone Number: __________________________
Volunteer Work:
“I hereby authorize the release of any information concerning this scholarship application that may be
necessary for the selection process. If I choose to revoke this authorization, I shall notify you in writing
of such circumstances.”
____________________________________________
SIGNATURE
_____________________
Date
Please use the back of this form to provide any additional pertinent information you would like the committee to
consider. Return this application to the Financial Aid Office by 5:00 p.m. January 29th, 2016.
YOU WILL BE CONSIDERED FOR ALL SCHOLARSHIPS FOR WHICH YOU MEET THE DONOR’S
CRITERIA. YOU WILL NOT BE CONSIDERED IF YOU DON’T MEET THE CRITERIA ESTABLISHED BY
THE SCHOLARSHIP COMMITTEE (see above).
MSU-Northern does not discriminate on the basis of race, color, national origin, sex or disability.