APPLICATION FOR STAFF DEVELOPMENT TEXTBOOK SCHOLARSHIP

Name:
Student ID#:
SAP ID#:
Department:
Campus:	OxfordJacksonTupeloSouthaven
Title:
E-Mail:
Phone:
Have you previously received this scholarship:	YesNo
If yes, when:
Salary Range:	Less than $22,000 $22,001 - $35,000 $35,001 - $50,000
Term Enrolled:	Choose TermFallSpringSummerInd. Study
Number of Classes in Which Enrolled:	123
Course One Name:
Course One Number:
Course Two Name:
Course Two Number:
Course Three Name:
Course Three Number:
Title of Books and Materials: REQUIRED: This information MUST be completed before a voucher can be issued: NOTE: This scholarship will not pay for school supplies.
Total Costs of REQUIRED Materials:
I HAVE READ THE TERMS AND CONDITIONS OF THE TEXTBOOK SCHOLARSHIP ON THE STAFF COUNCIL WEBSITE, I UNDERSTAND AND ACCEPT ALL OF THE STATED TERMS AND CONDITIONS OF THE SCHOLARSHIP.	Yes No
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