Social Security Number:
Day Phone: Evening Phone:
For the Spring 2012 Semester, check student status:
Full-time(13 credits or more per sem.)
Part-time (Less than 13 credits per sem.)
Name of Employer:
Does your employer give any tuition assistance? Yes No
If yes, what percentage of tuition is covered?
Are you a full-time member of the clergy? Yes
By submitting this form electronically, you are giving the Graduate Scholarship Committee the right to review this material and to examine the transcripts of all of your academic progress.