ESCAMBIA FEDERATED REPUBLICAN WOMEN'S CLUB LEE BAINES MEMORIAL SCHOLARSHIP APPLICATION THIS APPLICATION IS VALID FOR THE 2008 ACADEMIC YEAR. PRINT (IN BLUE OR BLACK INK) OR TYPE THE FOLLOWING SSN#_____________________________NAME__________________________________________ (LAST/FIRST/MI) MAILING ADDRESS: ______________________________________________________________________________ P. O. BOX or STREET/APT. CITY/STATE/ZIP HOME PHONE_______________________ CELL PHONE______________________ ARE YOU A REGISTERED REPUBLICAN? _____ YES_____ NO VOTER REGISTRATION#____ ______________ EDUCATION: WHAT COLLEGE DO YOU ATTEND? ______________________________________________ WHAT IS YOUR DECLARED MAJOR?_____________________________________________ WHAT IS YOUR GPA?_________________ WHAT DEGREE ARE YOU PURSUING?______________________________________________ HOW MANY SEMESTER HOURS HAVE YOU COMPLETED?___________________________ ACTIVITIES: LIST ACTIVITIES AND LEADERSHIP POSITIONS, ACADEMIC OR EXTRACURRICULAR HONORS OR AWARDS (COLLEGE, COMMUNITY SERVICE, VOLUNTEER) RECEIVED. (ATTACH ADDITIONAL PAGES IF NECESSARY) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

PERSONAL STATEMENT: SUBMIT A PERSONAL STATEMENT DESCRIBING REASONS FOR PURSUING YOUR MAJOR AS WELL AS YOUR CAREER GOALS (500 WORDS OR LESS) RECOMMENDATIONS: YOU MAY SUBMIT UP TO THREE (3) LETTERS OF RECOMMENDATION FROM A FACULTY MEMBER OR INSTRUCTOR WHO KNOWS WELL YOUR ACADEMIC WORK AND CAN SPEAK TO YOUR STRENGTHS IN YOUR ACADEMIC MAJOR.   I CERTIFY THAT THE INFORMATION ON THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE; ALL ACCOMPANYING DOCUMENTS ARE AUTHENTIC, UNALTERED RECORDS THAT PERTAIN TO ME.   ________________________________________________/_________________________________ SIGNATURE/DATE