Membership Dues Scholarship Application

Legal Name*

Email*

Cell Phone*

Home Phone

Street Address*

City*

State / Province*

Postal Code / Zip Code*

Student ID*

Semester& Year in which you are applying*

Please answer these questions in complete sentences and provide specific information when appropriate.

Why are you interested in becoming a member of Phi Theta Kappa at Cowley College and what would you bring to our chapter?*

Have you applied for federal financial aid?*

Yes

No

If you answered YES to the question above, mark all that apply. If you answered NO, skip to the next question.*

I am NOT eligible for a Pell Grant

I am eligible for a Pell Grant

I am eligible for a student loan

Why are you requesting this financial assistance?*

A requirement of this scholarship is to volunteer at least three (3) hours to help with one of our activities, either in Mulvane or Arkansas City.

Will you be able to fulfill this requirement?*

Yes

No

Please provide the names of two Cowley College faculty members who could provide a recommendation for you.

Full Name of First Reference*

Phone or Email*

Full Name of Second Reference*

Phone or Email*

May we contact the references you have listed above?*

Yes

No

I certify that all the information I have provided on this application is complete and correct to the best of my knowledge.*

Yes

PTK Scholarship Application