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2014-2015 General Scholarship Application

Please read the application carefully and answer all applicable fields before submitting. Failure to complete the form thoroughly or not providing required items in a timely manner will result in a rejected application. Application must be submitted by the deadline specified.

Note: This application will be submitted for all applicable UTB General Scholarships. If you submit more than one application, your last application will be the one to be reviewed.

To the extent provided by applicable law, no person shall be excluded from participation in, denied the benefit of, or be subject to discrimination under any program or activity sponsored or conducted by The University of Texas System or any of its component institutions on the basis of sex, race, color, national origin, religion, disability, age, or veteran status.


Full Name *


UTB ID# *


Email *


Daytime Phone *


Mailing Address *


Citizenship


Texas Resident

Current Classification


Major Field of Study *


Minor Field of Study


Cumulative GPA *


Employed

Hours per week


Volunteered

Activities/Organizations, Hours


Personal Statement

Provide a typed one or two page personal statement to the Scholarship Committee. The statement should include an organized brief history of your background, educational and career goals, and any your community service and or volunteer work you have done. Being as specific as possible will assist the committee in the selection process.


Personal Statement *


Nepotism Statement

State law requires that each student identify any relation to a current Board of Regents member or Board of Trustees member. A student who is related to a current member of the University of Texas Regents is prohibited from receiving scholarships unless the scholarship is awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B misdemeanor to file a false statement.

Please review a list of current members of The University of Texas System Board of Regents at http://www.utsystem.edu/board-of-regents/current-regents and then select the most appropriate answer below indicating your relation to any of the UT System Board of Regents members.


Nepotism Statement

Certification Release and Signature

I certify that the information given is true and correct to the best of my knowledge and allow the Financial Aid Office at The University of Texas at Brownsville to release any of the information to the individual(s) selecting or given the scholarship, upon their request.


Signature *


Date *


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