The Independent Scholarship Application

Deadline - April 5, 2010

Return or mail the completed application to

The FLC Foundation Office 1000 Rim Drive

Durango, CO 81301

Incomplete applications will not be accepted

Personal InformationName _________________________________________________________________ SS# or FLC ID# ______________________________________

Complete Address ___________________________________________________________________________________________________________

City ______________________________________ State _______________ Zip _____________ County _____________________________________

Address After April 30, 2010 ___________________________________________________________________________________________________

City ______________________________________ State _______________ Zip _____________ County _____________________________________

Phone _________________________ Date of Birth __________________ Gender: M____ F ____

Ethnicity/Race: For Scholarship Requirements Only. Circle one below:American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White

Father’s Name _____________________________ Mother’s Name ____________________________ or Spouse _______________________________

Father/Mother/Parent’s Address ________________________________________________________________________________________________

Residency for tuition purposes: In-State ____ Out-of-State ____

Academic/ActivitiesHigh School ____________________________________________________________________ Year Graduated ____________ GPA_____________

Hometown Newspaper _______________________________________________________________________________________________________

Journalism or Other Applicable Experience _______________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

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Desired Position on Independent Staff. Circle one below:

Reporter Copyeditor Photographer Designer Master Web Design/Online Maintenence Advertising/Public Relations Other/_____________

FLC Class StandingFor the 2010-2011 Academic Year what will your class standing be? Freshman _________ Sophomore _________ Junior _________ Senior __________

FLC Credit Hours Completed ______________________________________________ FLC Cumulative GPA __________________________________

Number of Credit Hours you plan to take in Fall 2010 _______________________________ Winter 2010 _____________________________________

FLC Major _________________________________________________________________________________________________________________

Activities/Honors ____________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Future Plans ________________________________________________________________________________________________________________

Related to FLC Alumnus? Yes ___ No ____ Relationship ____________________ Name __________________________________________________

One copy of transcipts attached - Yes ____ Statement of Purpose attached - Yes _____

Statement of PurposePlease write a one page essay explaining how you could contribute to the Independent Staff and why you are deserving of the Independent Newspaper Scholarship.

_____________________________________________________________________ _____________________________________________

Student Signature Date

Return or mail completed application to address on front or deliver to Sandy Jameson in the Foundation Office, 2203 Berndt Hall