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KANSAS GEOLOGICAL FOUNDATION
212 N. MARKET, STE. 100
WICHITA, KANSAS 67202
(316) 265-8676
Fax (316) 265-1013

SCHOLARSHIP APPLICATION


APPLICATION FOR: Semester Application Deadline
(Check and date only one) Spring 2010 December 1, 2009 
Fall  2010 May 1, 2010

PERSONAL INFORMATION:

1.  Name:

Last Name   First Name Middle

2.  Date of Birth:
Month Day Year

3.  Male __ Female __
4.  Citizenship: US __ Other __________________________________________________________
5.  Marital Status: Single __ Married __ Widowed __ Divorced __ Separated __
6.  Home Address: Street: ___________________________________________________________

                                City: ____________________________ State: __________________________

                                Zip: _____________________________ Phone: _________________________
7.  Check your present classification as a student:
                             __ Junior __ Senior __ Graduate Student

8.  University now enrolled in: _________________________________________________________

9.  Educational experience: (beginning with high school)

     
    Name of School or College
    Address
    		 Years of Attendance
    Degree / Diploma & Year

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    __________________________________________________________________________________________________________________________________

    ______________________________________________________________________________________________________________


10.  What is your intended professional emphasis in the field of geology or earth Science?_____________________________________________________________________________________

11.  If you plan to teach, indicate specific level and subjects you wish to teach:  _______________________________________________________________________

12.  Have you previously been a recipient of a K.G.F. scholarship and if so, when ?  NO____  YES____   Fall Semester ________(year)    Spring Semester _______ (year)

13.  Please attach a separate page to tell of offices held, honors won and work experiences.

14.  Please give a statement of why you think that the K.G.F. should sponsor your scholarship:
 
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

15.  Parent’s Name: __________________________________________

Phone:__________________________
Parent’s Address: _________________________________________________________________
( Street, State, City, and Zip Code)
Mother’s Occupation: _______________________ Place of Employment: _____________________

Father’s Occupation: _______________________ Place of Employment: ______________________
 
Date Applicant's Signature

*** WE MUST HAVE YOUR DEPARTMENT CHAIRMAN’S RECOMMENDATION BELOW !
 

RECOMMENDATIONS

Chairman, University Department of Geology / Earth-Science

Approve ______________ Disapprove ___________ Amount _____________ Date _____________

Name _______________________________________________________


 
 

KGF SCHOLARSHIP COMMITTEE

Member ____________________________________ Approve ________ Disapprove ____________

Amount: ____________________________ Date: ___________________________________________
 
 
 
 
 
 
 
 

Member ____________________________________ Approve ________ Disapprove ____________

Amount: ____________________________ Date: ___________________________________________

COMMENTS: