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:

Julie Messerole 10516 Y Street Omaha, NE 68127 nebraskacotteyscholarship@gmail.com

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)

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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, 2017

__________________________________________

Applicant’s Signature

__________________________________________

Date

Mail to: Julie Messerole 10516 Y Street Omaha, NE 68127 nebraskacotteyscholarship@gmail.com

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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:

Julie Messerole 10516 Y Street Omaha, NE 68127 nebraskacotteyscholarship@gmail.com

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Report from the 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:

Julie Messerole 10516 Y Street Omaha, NE 68127 nebraskacotteyscholarship@gmail.com

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