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Dr. Mitchell Holifield, Chair

Educational Leadership, Curriculum & Special Education

Arkansas State University

P.O. Box 2781

State University, Arkansas 72467

Applying for:                               Reng Scholarship                                  Ham Scholarship

Name:                                                                                      SSN:                                                   

Current Mailing Address:                                                                                                                     

                                                            Street                                       City, State, Zip

Telephone: Home:                                                         Work:                                                             

E-Mail:                                                                         Cell:                                                                

Undergraduate:

Institution:                                             Degree:                         Major:                                               

Date of Graduation:                                                      Undergraduate GPA:                                       

Area(s) of Teacher Certification:                                                                                                          

Years of Teaching Experience:                                                                                                 

Graduate:

I have been admitted to Graduate School at Arkansas State University and I am pursuing a degree in educational administration.  I have a graduate GPA of                       over                 graduate hours.

I plan to pursue graduate work as a                    full                    part time student.

Additional information that might be helpful in evaluating your application.  (MAT score, GRE, academic hours, special awards, special qualifications of reasons for applying for this scholarship).

Submit a short autobiography (early background, work experiences, educational experiences and a short statement stating why you want to work in the educational administration area).

                          Signature                                                                                    Date