APPLICATION FOR WILLIAM F. TAGGART SCHOLARSHIP

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APPLICATION FOR

WILLIAM F. TAGGART SCHOLARSHIP

1. Name_________________________________________

2. Address_______________________________________

City/State Zip ____________________________________

3. Present Position_________________________________

4. Degree(s) Date(s), Institution(s), Major

5. Department in which graduate study will be completed.___________________________
Number of hours completed as of this application. _____________

6. Names of specific course or activity for which scholarship is to be used.

7. Dates and duration of activity.

8. Location of activity.

9. Professional association(s) of which you are member.

10. Attach a one (1) page letter stating how this learning experience will help support your immediate and/or long-term professional improvement goal(s).

Signature of Applicant ________________________
Date ___________________

(Recommendations and Actions on Reverse Side)

RECOMMENDATION/ACTION

DISTRICT EXTENSION DIRECTOR: _____________________________

Recommended action and comments:

District Extension Director Signature ________________________
Date _________________________

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SCHOLARSHIP SELECTION COMMITTEE:

Recommended action: Approved Not Approved

Amount of Scholarship: _____________________
Date: ____________________

Comments:

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DEAN AND DIRECTOR:

Action taken and comments:

Vice President, Dean and Director Signature: ________________________
Date: _____________________