WYOMING ASSOCIATION OF PUBLIC ACCOUNTANTS
SCHOLARSHIP APPLICATION FUND.

For Wyoming Students Enrolled in the Pursuit of Accounting Education.

 

MICHAEL LIESCH, VP                                                                                                JARVIS WINDOM

P O BOX 25                                                                                                                      1064 GILCHRIST ST

THERMOPOLIS, WY  82443                                                                                       WHEATLAND, WY  82201

307-864-2888                                                                                                                  307-322-3433

mikepa@directairnet.com                                                                                             jarvis@windom.org                                            

 

IMPORTANT:

  1. Your application will be evaluated in part on how well you follow instructions when you complete this form
  2. All information provided by applicants will be considered confidential.
  3. To receive WAPA Scholarship Funds, candidates must be Wyoming Residents enrolled or accepted by an accredited
  4. school within the State of Wyoming as fulltime accounting or business related student carrying a minimum of 12 credit hours.
    PLEASE PRINT OR TYPE.

 

Name in Full: _______________________________________________________________________________________

                              FIRST                                                 MIDDLE                                                           LAST

Present Address: _____________________________________________________________________________________

                                    STREET                            CITY                 STATE  ZIP                        PHONE

Permanent Address: __________________________________________________________________________________

                                        STREET                      CITY                   STATE  ZIP                        PHONE

U.S. Citizen: _____Yes _____No     State of Wyoming Resident: ______________________________________________

Length of residency in Wyoming: ____________ years

Marital status:  _____Single     _____Married    _____Separated     _____Divorced     _____Widowed

               Ages of children (if any): _______________________________________________________

If married, Name of Spouse: ___________________________________________________________

Spouse’s Occupation: ________________________________________________________________

Professional field you plan to enter: _____________________________________________________

Name and Address of the College, Community College or University you plan to attend:

Name:_____________________________________________________________________________

Address:___________________________________________________________________________
Degree to be received: ________________________________________________________________

Date you plan to attend:  From ____________ to ___________ (Mo/Yr)

Have you applied for admission to the school? __________YES   __________NO

Have you been accepted?  __________YES  __________NO

                              (PLEASE SEND US A COPY OF YOUR LETTER OF ACCEPTANCE.)

Are you an existing student at the school?  __________YES  __________NO

List High School from which you graduated and Colleges you have attended:

 

Name of School

City & State

From - To

Major Field

Degree Earned

High School

 

 

 

 

 

College

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please enclose your transcripts from high school and college.  If a transcript is unavailable by the ____________ deadline for applications,

mail your application by the deadline without the transcript but tell us when the transcript will be available.

 

Explain and unusual circumstances regarding your financial status in the following space.  It may be to your advantage,

for instance, for the committee to know your family size or special needs.

 


Employer and Job

Description

 

Full/Part-time

Dates of

Employment

 

 

 

 

 

 

 

 

 

REFERENCES.

When you supply information requested below, you are giving the committee permission to contact your references.

 

PERSONAL CHARACTER REFERENCE

NAME: ____________________________________________     PHONE: _____________________

ADDRESS: ________________________________________________________________________

                              Street                                       City                                      State                                    Zip

 

PROFESSIONAL REFERENCE:

NAME: ____________________________________________     PHONE: _____________________

ADDRESS: ________________________________________________________________________

                              Street                                       City                                      State                                    Zip

 

PRINT a brief paragraph giving your reasons for wishing to study in the professional field of accounting.

 (Example:  When did you first become interested?  What opportunities have you had to observe the practice of the profession?)

 

 

If your previous education has been interrupted because of illness, employment, finances, travel, etc., please explain:

 

Because competition for awards may be very great, in the question below it will be to your advantage to clarify the

need for financial assistance as completely as possible:

Projected School Costs:

               Your school year is _____Months  _____Quarters  _____Semesters ______Tuition $_______________ 

Food & Housing $_______________  Personal $______________ Books & Supplies $_______________ 

ransportation $_______________  Other personal $_______________ (Daycare, monthly payments, insurance)

 

Your sources of financial support:

 

SOURCE

Approximate annual income of

source, if applicable

Estimate amount of support in dollars you will receive from this source

Parent or Guardian

 

 

Spouse

 

 

Self

 

 

Others (Financial Aid, Social Security, other scholarships, etc)

 

 

Areas of your special interest and proven leadership ability:

 

 

List of other scholarships for which you have received or will receive.

 

STATEMENT OF APPLICANT

 

If I am granted a scholarship, it is my intention to complete the educational program outlined

 I agree to inform the Wyoming Association of Public Accountants Scholarship Fund immediately if

 I am no longer interested in preparing for the profession indicated or if my plans change.  I also agree for WAPA

to publish my name and awards in their material. 

I agree that this application and all credentials submitted by me or others on my behalf will remain the property

of the Wyoming Association of Public Accountants Scholarship fund.

 

____________________                                     _______________________________________________________

               Date                                                                                          Signature of Applicant