Emily Krauz Staff Endowment Scholarship Application

Deadline for receipt of the next applications for courses being taken during Fall 2009 will be
November 1, 2009 at 5 p.m.

ELIGIBILITY REQUIREMENTS: Applicants must be permanent resident aliens or U.S. citizen, non-probationary, benefits eligible (.50 FTE or more) career staff members at the University of Arizona. Previous recipients of the Staff Endowment Scholarship are eligible for the semester immediately following the semester of their most recent award. Please direct any questions regarding eligibility to Shana McClelland

Complete this form then press the submit button at the bottom of this page.

EMPLOYEE INFORMATION - all fields are required.

Name:
E-mail:
Department:
Campus address:
Work phone:
Position:
Time in current position:	yrs, mos
Time at university:	yrs, mos
Pay grade:
Supervisor:
Supervisors phone:
Degree (s) currently held:	BA/BS; MA/MS; PhD; Other
Are you pursuing?	BA/BS; MA/MS; PhD; Professional development; Other
Are you a permanent resident alien or U.S. citizen?	Yes or No
Have you ever won this award before?	Yes or No
If so, when? (enter MM/DD/YR or never)

Please describe the class(es) or workshops you are taking and how they benefit you, your current position, professional career and future. Please be specific.

FUNDING DESCRIPTION - Original receipts will be required for reimbursement. Some fees will not be allowed such as costs for parking, penalties, contributions or subscriptions.

Please check each type of funding you are requesting and provide a detailed description and estimated cost.

Tuition/fees

Institution you are attending:

Please provide a description and estimated cost for each item.

Required Textbooks

Please provide a description and estimated cost for each item.

Other required materials

Other course work required expenses requested to assist the employee in attending class(es) or for job enhancement. Please provide a description and estimated cost of each item.

Total Amount Requested:

This scholarship is funded by individual University employees and the Emily Krauz Staff Endowment Fund.

By submitting this form, I affirm that the above information is correct and the requested reimbursement will not be funded by any other source such as college and/or departmental support.

Please answer each applicable question completely. If you have questions regarding the completion of this application, contact Shana McClelland.

updated 09/03/2009 gea

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SAC Tel: (520) 621-3931