University of Wisconsin–Madison Division of Continuing Studies

Wisconsin Women of Color Network, Inc.,
Mabel Smith Memorial Scholarship Application

Application deadline: Varies in February, applications must be postmarked before the deadline.

Print or type all information except your signature.

Name (First, Middle Initial, Last)

Address (Street, City, State, Zip)

Phone (                                    )

Birth Date (                  )    Sex    (Circle one):    Female    Male

Ethnic (Circle one):     African American     American Indian    Asian     Hispanic     Biracial

Name of High School

Address (Street, City, State, Zip)

Principal's Name

Phone (                                    )

Graduation Date (                  )    Grade Point Average-GPA (                  )

School/Community/Organization Activities

Name of Community College or Vocational Technical School You Plan to Attend

Name

Address (Street, City, State, Zip)

Advisor Name

Major

Have you been accepted for admission in your selected program? (Circle one)    Yes     No

When do you plan to attend? (                  )

Estimated amount of: Tuition $ (                              ) Fees $(                              ) Books $ (                              )

Have you received, or been offered, any other scholarship or grant? (Circle one)    Yes     No   

If yes, amount awarded $ (                                    )

Career Goals

Reason(s) you are requesting a scholarship

References

Name (First, Middle Initial, Last)

Address (Street, City, State, Zip)

Phone (                                    )

Name (First, Middle Initial, Last)

Address (Street, City, State, Zip)

Phone (                                    )

Financial Background

Please complete the following information to the best of your ability.

Can your parent(s) or guardian(s) afford to contribute to your education? (Circle one)    Yes     No*

How much per year? Parent(s) $ (                              ) Legal Guardian(s) $ (                              )

How much can you contribute?$ (                              )

*If no, please explain

What is your college or vocational/technical goal?

Materials required:

Completed application form.

One-page essay--typed or printed and double-spaced--on how this scholarship will help you accomplish your educational goal.

Three letters of recommendation written by an instructor, guidance counselor, or individual who can attest to your educational abilities.

High-school transcript from the end of the first semester of your senior year. GED applicants: submit a copy of your certificate of completion.

A black-and-white photo (if you are granted an award).

Applicant's signature and date

Scholarship List   Information

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