Cover sheet nebraska Cottey Scholarships Application Form for Renewal of a P. E. O. Scholarship

COVER SHEET

Nebraska Cottey Scholarships

Application Form for Renewal

of a P.E.O. Scholarship

**** Applicant completes this Cover Sheet and pages 1 and 2. Page 3 is to be completed by the Cottey College Registrar. Page 4 is to be completed by the Cottey Dean of Student Life.

Pages 3 & 4 shall be returned directly to the Nebraska Cottey Scholarship Chairman

by Cottey personnel. ****

Name of Applicant ____________________________________________________

Home Address ______________________________________________________

Cottey Address ______________________________________________________

College Phone _____________________ Home Phone _____________________

State P.E.O. Chapter: Nebraska State Chapter

Name of State Scholarships Chairman:

Mary Berner

424 S. 11th Street

Plattsmouth NE 68048

A brief statement as to why the scholarship is needed:

Nebraska Cottey Scholarships Application

Second, Third or Fourth Year Student

(Applicant must be declared in good standing by Cottey College before scholarship can be awarded)

Name ___________________________________Phone ______________________

Address _________________________________Email _______________________

_________________________________

Father’s Name _____________________________Occupation __________________

Address ____________________________Phone ______________________

____________________________

Mother’s Name _____________________________Occupation __________________

Address ____________________________Phone ______________________

____________________________

****Applicant must be sponsored by a P.E.O. Chapter****

Sponsoring P.E.O. Chapter ______ City _____________________________________

Name and address of P.E.O. Chapter’s President ______________________________

__________________________________________________________________

Please fill out application and include it with the following materials:

1. 4” X 6” photo taken on the Cottey campus with location description, and your position if a

group photo is sent (Photo will not be returned and will be used in convention display.)

2. A copy of applicant’s letter to the P.E.O. chapter requesting sponsorship

3. Letter of recommendation on official letterhead (no email) from:

- Sponsoring P.E.O. chapter

- Faculty member from Cottey College

- A staff member at Cottey College (may be any staff member or another faculty

member if you wish)

-1-

4. Transcript of all Cottey Credits (C, or 2.0 on a 4.0 scale average is required)

5. Application Form for renewal a P.E.O. Scholarship (complete as per instructions)

6. A statement outlining intended major, career plans after leaving Cottey.

THE SCHOLARSHIP CHAIRMAN MUST RECEIVE THE COMPLETED APPLICATION

BY March 1, 2016

__________________________________________

Applicant’s Signature

__________________________________________

Date

Mail to: Mary Berner

424 S. 11th Street

Plattsmouth NE 68048

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Report From The Registrar
Number of credits completed first semester ______________________

Anticipated number of credits to be completed second semester ___________________

Grade point average at the end of first semester ___________

Dean’s List: Yes _____ No _____ President’s List: Yes _____ No _____

Do you recommend this student for a scholarship for her second year at Cottey College?

Yes _____ No _____

Signature: _____________________________________ Date __________________

Registrar

Please return to:

Nebraska Cottey Scholarships Chairman:

Mary Berner

424 S. 11th Street

Plattsmouth NE 68048

(3)

Report from fhe Dean Of Student Life

Has this student been subject to any disciplinary sanctions by the college during the past year?

Yes _____ No _____ If yes, please explain:

Has this student been selected for any special responsibilities, elected to any offices or received any honors? Yes _____ No _____ If yes, please specify:

Do you recommend this student for a scholarship to Cottey College?

Yes _____ No _____

Signature: _____________________________________ Date __________________

Dean of Student Life

Please return to:

Nebraska Cottey Scholarships Chairman:

Mary Berner

424 S. 11th Street

Plattsmouth NE 68048

(4)