PERSONAL DATA
Title:
First Name: Last Name:
UIN:
Expected Graduation Date:
UIC E-mail Address:
Address:
City: State:
Zip:
Telephone Number (Home): (Area Code & Phone#)
Are you currently receiving financial aid: Yes No
* Receiving a scholarship may impact your campus-based financial aid
and/or adjust your overall financial aid package. Consultation with the
Financial Aid Office should be done prior to the distribution of any
monetary award.
ETHNIC BACKGROUND
Ethnic Background:
Mexican American Puerto Rican Other Specify
ACADEMIC HONORS AND ACTIVITIES
List any academic honors you have received:
Extracurricular activities (explain your role in these):
Scholarships or other financial aid for 2007 - 2008
academic year(be specific and state type of aid or
scholarships and amount, please estimate if you don 't
know exact amount):
PERSONAL STATEMENT
Prepare a personal statement no longer than one page
addressing how receiving a CBA scholarship would
impact you financially and academically; discuss any
financial hardships that you may have had and finally
share information about your background that have
contributed to your academic experience/success.
The statement is one of the most important aspects
of this application and is equivalent to an interview.
RESUME
Kindly copy/paste your resume here (plain text format):
SUBMIT APPLICATION
I certify that the information provided on this scholarship
application as well as the supporting documents are
accurate and official.
Student Name:
Date: Month: Day: Year:
The information submitted above will be kept confidential
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