Wufoo

Legal Name * First Last
Email *
Cell Phone * ### - ### - ####
Home Phone ### - ### - ####
Street Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student ID *
Semester & Year in which you are applying *
Please answer these questions in complete sentences and provide specific information when appropriate.
Why are you interested in becoming a member of Phi Theta Kappa at Cowley College and what would you bring to our chapter? *
Have you applied for federal financial aid? *
Yes No
If you answered YES to the question above, mark all that apply.
I am NOT eligible for a Pell Grant I am eligible for a Pell Grant I am eligible for a student loan
Why are you requesting this financial assistance? *
Volunteer Requirement

A requirement of this scholarship is to volunteer at least three (3) hours to help with one of our activities, either in Mulvane or Arkansas City.
Will you be able to fulfill this requirement to volunteer? *
Yes No
Please provide the names of two Cowley College faculty members who could provide a recommendation for you.
Full Name of First Reference * First Last
Phone or Email of First Reference *
Full Name of Second Reference * First Last
Phone or Email of Second Reference *
May we contact the references you have listed above? *
Yes No
I certify that all the information I have provided on this application is complete and correct to the best of my knowledge. *
Yes
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