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Scholarship Application Template - Western Illinois University Fallen Soldiers Scholarship Page 2

Fallen Soldiers Scholarship

DEADLINE: July 30, 2016

Veterans Resource Center

Western Illinois University

1 University Circle, Macomb IL 61455

Phone: 309-298-3505

Student Name: _________________________________________

_________________________

________

Last

First

M.I.

WIU I.D. #: ____________________________________

Cell Telephone #: _______________________

___

School Residence (Street Name): _________________________________________________________________

City: ________________________________

County and/or Township ________________________________

State: __________________

Zip Code: ________________

Cell Telephone #: ________________________

Permanent Residence (Street Name): ______________________________________________________________

City: ________________________________

County and/or Township ________________________________

State: __________________

Zip Code: ________________

Cell Telephone #: ________________________

Academic Major _____________________________

Academic Minor _______________________________

The following documents must be submitted with this application form. Fax or email submissions will not be accepted.

• Submit a written essay (500 words or less) describing how your military service has influenced your intellectual,

academic and personal life experiences.

• Submit a copy of the DD Form 214 with notation of an honorable discharge or a letter from your Commanding Officer

documenting service.

• Submit an unofficial copy of your Western Illinois University transcript (may be printed through STARS).

Student Signature ____________________________________________

Date _____________________________

Return the completed application, essay, DD Form 214, and transcript to the Veterans Resource Center,

1 University Circle, Macomb, IL 61455. All application materials for the fall 2016 term scholarship

must be received on or before July 30, 2016. Application materials will also be accepted if postmarked

no later than July 30, 2016.

Scholarship Application Template - Western Illinois University Fallen Soldiers Scholarship Page 2