SCHOLARSHIP APPLICATION
NATIONAL ASSOCIATION OF
JUNIOR AUXILIARIES, INC.
Scholarship Committee
P.O. Box 1873
Greenville, Mississippi 38702-1873

NOTICE:

DETAILED INSTRUCTIONS ARE ON PREVIOUS PAGES. 

Please complete all fields in this form completely and accurately, and be as concise as possible in explanations.   

Last Name First Name Middle
Permanent Address: City State Zip
Current Address if Different from above City State Zip
E-mail Address: Permanent Telephone:
(including area code)		 Current Telephone:
(including area code)

Name and address of nearest relative:
Name: Relationship:
Street Address City State Zip

Are you a U.S. Citizen? Yes No

Proposed Field of Study: If Other explain:
 
(Maximum characters: 250)
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Degree you will work to obtain: If Other explain:

(Maximum characters: 250)
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Please list employment you have had within past five years:  (maximum of 256 characters/field)

Employer Job Title From Date
(mm/yyyy)		 To Date
(mm/yyyy)

Please list colleges and/or universities that you have attended: (maximum of 256 characters/field)

Name and Location of school
(Also specify YOUR name if different at time of attendance)		 Dates Attended Degree Received GPA

List four (4) pertinent items which may include college honors, scholarship or special recognition, civic or cultural involvement and volunteerism.

(Maximum characters: 500)
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Name and Location of College or University  to which you have applied:

Have you been accepted into this graduate program?  Yes  No

Date your studies began/will begin:   Month    Year 

Will you be able to earn your degree within this scholarship year ?  Yes  No  If NO, please explain:

(Maximum characters: 500)
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Estimated Expenses per term - June 1 through May 31
(Enter values in whole dollar amounts)

  SUMMER FALL WINTER SPRING
Tuition/fees
Books(estimate)
Room/Board
Other
TOTALS $ $ $ $
GRAND TOTAL $
Hours to be taken        

Is this request for Semester or Quarter terms ? 

APPLICANT'S COMMENTS:   In 350 words or less provide reasons for choosing this profession,
motivation to pursue this degree, commitment to work with children and future goals.

(Maximum characters: 2500)
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CERTIFICATION (MUST BE SIGNED AND DATED)

I certify that the information given in this application is complete and accurate to the best of my knowledge. If I accept the NAJA Scholarship, I agree to fulfill the following obligations:

TO MAINTAIN A HIGH LEVEL OF SCHOLARSHIP AND BEHAVIOR AND TO SEND TO THE SCHOLARSHIP COMMITTEE A TRANSCRIPT OF ALL GRADES RECEIVED DURING THE SCHOLARSHIP PERIOD.

TO NOTIFY THE SCHOLARSHIP COMMITTEE OF ANY CHANGE OF NAME OR ADDRESS OR OF A CHANGE IN MY MAJOR FIELD OF STUDY OR SCHOOL.

Signature ___________________________          Date _____/___/_____
 

  
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APPLICANT'S COMMENTS: In 350 words or less, provide reasons for choosing this profession, motivation of this degree, COMMITMENT TO WORK WITH CHILDREN and future goals.