Application

McCann Student Academic Development Fund

2001-2002

(Please print)

Name: __________________________________________________

Social Security Number: ___________________________

Currently enrolled as: Full-time Student ______________

Part-time Student ______________

Classification: Freshman ______

Sophomore ______

Junior ______

Senior ______

Graduate ______

Major: ___________________________ Major GPA: ________

Minor: ___________________________ Minor GPA: ________

Cumulative GPA: _________

Number of credit hours received at Texas Wesleyan University: _______________

Expected date of graduation: _______________

Please indicate the extent of your involvement (in years), any awards recognition received, and any offices held in each of the following areas.

a) List leadership qualities demonstrated both in and out of the high school/university setting:

2. List other activities (honorary organizations, religious groups, political organizations, civic groups, scouting, etc.) in which your participation made a difference to you or those around you.

Title of Proposal: _______________________________________________________________________

Dates involved: ______________________ to: ____________________________

Note: Applications should be received as early as possible, prior to the proposed event for maximum consideration.

If travel is involved, destination: __________________________________________________________

PROPOSAL: [Briefly describe the purpose of your proposal. Include (1) How this activity will enhance your education. (2) How this activity will help advance your career preparation. (3) how this activity will benefit Texas Wesleyan University. Please be specific. You may attach additional sheets if necessary.]

REQUESTED FUNDS: OTHER SOURCES OF FUNDING:

Please itemize as follows: (If applicable)

Transportation: ____________ Department Name: ____________ _

Lodging: ____________ yes_____ no _____ If yes,amount committed:_____

Meals: ____________ School Name: _________________________

Registration Fee: ___________ yes ____ no _____ If yes, amount committed: _____

Miscellaneous Costs: ________ Other Sources: ______________________________

TOTAL: ____________ yes _____ no _____If yes, amount committed: _____

Faculty /Administrative Endorsement:

Letters of endorsement/recommendation are required from at least two faculty members, one of whom must be in the department of your major. Additional letters of support may be submitted as applicable to the proposal. These letters should be enclosed with this application.

Names of Recommenders:

Faculty: _______________________________ Title: _________________________

Faculty: _______________________________ Title: __________________________

Other: ________________________________ Title: __________________________

Dean’s Recommendation and Disposition:

[Check appropriate box (es)]

__

/_/ Funding from School’s account

Amount Approved: ________________ Account Number ______________________

__

/_/ Denying request

Reason(s) for denial:

__

/_/ Submitting to Review Committee

Please complete the following:

________________________________ _________________________

Dean’s Signature Date

Review Committee Action (if applicable): If approving request, please complete the following:

Amount Approved: _______________ Account Number: ________________

_______________________________ _______________________________

Chair’s Signature Date

Provost Endorsement and Disposition:

________________________________ ______________________________

Provost’s Signature Date

A written report will be required at the completion of each activity. This report is due no later than one month after the end date stated in the proposal. Complete funding will not be awarded until this report is provided

Final Report Received: _______________

Date