University of Wisconsin–Madison Division of Continuing Studies

The Jaycees of Wisconsin Foundation, Inc. Application


Application deadline: June 1.

Information will be verified and information found to be inaccurate will disqualify applicant.
Decisions of the Jaycees of Wisconsin Foundation Scholarship Committee are final.


Complete and return the application packet as described on the cover sheet. Mail to:

Foundation Scholarship Committee
c/o Wisconsin Jaycees
P.O. Box 1547, Appleton, WI. 54912


Name ( Last, First, Middle)


Address (Street, City, State, Zip)




Phone (include area code):



Date of birth:

E-mail address (optional):

Current G.P.A:

Degree(s) working toward:

1. Please provide your complete educational history below (high school to date).








2. Describe activities in which you have participated in within your community.









3. Identify honors and other recognition you have received. Include any scholarships you are currently receiving.









4. After taking a break in your education, why did you decide to return to pursue a degree?









5. How will this education help to prepare you to be a leader in your community?









6. Are there any obstacles, financial or otherwise, which will affect your pursuing this degree? If so, please describe.








Scholarship List    Information

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www.dcs.wisc.edu • Updated August 21, 2006