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 [email protected]
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, 2017
__________________________________________
Applicant’s Signature
__________________________________________
Date
Mail to: Julie Messerole 10516 Y Street Omaha, NE 68127 [email protected]
-2-
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 [email protected]
(3)
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 [email protected]
(4)
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