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The World Affairs Forum Norman Woodberry Scholarship for Study Abroad
 Application Form

  Available only to College and University students living in or attending school in Fairfield County, CT or Westchester, NY

Name: ___________________________________________________________________________

                                 First                                   Middle                                          Last                            

Social Security Number: ______-______-______ Resident: Westchester or Fairfield County ________

Address: ___________________________________________ City: _________________________

State: _____ Zip: ___________ Home Phone: _________________ Cell Phone: _________________  

Email: ___________________________________________________________________________

College/University you now attend (name and address):

 ________________________________________________________________________________

Expected Date of Graduation (mo/yr): _____________________ Date of Birth: ___________________

U.S. Citizen: Yes or No (please indicate current status): _____________________________________

Mother’s (or Guardian’s) Name: ________________________________________________________

Mother’s (or Guardian’s) Home Address: ___________________________________________

Home Phone: _________________________ Work Phone: ____________________________

Name and Address of

Mother’s (or Guardian’s) Employer: _______________________________________________

Mother’s (or Guardian’s) Title/ Position: ___________________________________________

Father’s (or Guardian’s) Name: ________________________________________________________

Father’s (or Guardian’s) Home Address: ___________________________________________

Home Phone: __________________________ Work Phone: ___________________________

Name and Address of

Father’s (or Guardian’s) Employer:________________________________________________

Father’s (or Guardian’s) Title/Position: _____________________________________________

1st Choice Study Abroad Program

Name of Institution/Program: __________________________________________________________

Location (City/Country): _______________________________________________________________

Time Period:  From (mo/yr): _________________________ To (mo/yr):_________________________

Have you applied?     Yes or No                         Have you been accepted?    Yes or No/Pending

Why did you choose this program?________________________________________________________

__________________________________________________________________________________

2nd Choice Study Abroad Program (if applicable)

Name of Institution/Program: ___________________________________________________________

Location (City/Country): _______________________________________________________________

Time Period:  From (mo/yr): __________________________ To (mo/yr):_________________________

Have you applied?     Yes or No                                     Have you been accepted?    Yes or No/Pending

Why did you choose this program?________________________________________________________________

______________________________________________________________________________________________

School and Community Activities and Awards (add page if desired)

Activity                                                                                                          Number of Years
Incl. Offices Held and/or Awards
_____________________________________________                                       _______________________

_____________________________________________                                       _______________________

_____________________________________________                                       _______________________

Employment Experience

Employer                                           Position                                                Dates

_______________________                 ______________________                      _______________________

_______________________                 ______________________                      _______________________

Please provide a 500 word essay on the following topics:

         How does your desired study abroad program fit into your educational or career goals?

         How will study abroad be of benefit to you and to the community in which you live?

Include with your application form the following:

         College Transcript (through Fall semester of 2014)

         Minimum of 2 recommendations – 2 professors or 1 professor/1 advisor required

         Copy of your FAFSA Student Aid Report or CSS/Financial Aid Profile

         If you are receiving financial aid from your home institution, provide a copy of your award letter

         An official statement from your school’s financial aid office or study abroad office that outlines your
  school’s policies regarding transferability of your financial aid to the program that you propose to do
  abroad.

         Copy of first two pages of parent’s most recent federal income tax return.

         (Optional) Letter describing any extenuating circumstances.

Student and Parent Statement:

We understand that this is only a scholarship application and that the World Affairs Forum does not make any representations or assurances regarding the availability of scholarships. 

We represent that this application reflects the work of the scholarship candidate.

We understand that any false statement, alteration or omission of pertinent information from this application will be considered just cause for removal of application from consideration.

Date:_________________________

Student (signature required):                                           Parent or Guardian (signature required):

_____________________________                                   ________________________________

 

Kindly return your completed application postmarked no later than March 31, 2014, to:

Norman Woodberry Scholarship Program
World Affairs Forum
30 Oak Street, Suite 105
Stamford, CT 06905

 

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