3.  Social Security #:_________________________    Student ID #:__________________________

4.  Off-Campus Address:___________________________________________________                                                              Street                                                                                  Apt
     _________________________________________________________________                                              City                                                  State                                            Zip

5.  TWU Address: Box____________________ Dorm________________________

     Phone # (____)______________________ Cell Phone # (____)_______________________

6.  When did (or will) you graduate from high school? ______________________________________

7.  Name of High school:_________________________ City:________________ State:__________

8.  Your classification during the poeriod for which you ar making application:
     Freshman:_______ Sophomore:________ Junior:_______ Senior:_______ Graduate:_______

9.  Anticipated date of graduation from TWU?:____________________________________________

10. Which profession do you wish to pursue?
      Speech Pathology:_________________ Education of the Hearing Impaired:_________________

11. Which semester are you appplying for financial aid?
      Semester: Fall___________ Spring____________ Summer____________ Year_____________

12. List Extra curricular activities in which you participate:

      ______________________________________________________________________________

      ______________________________________________________________________________

13.  List honors you have received and not when they were awarded to you in high school and/or college.

      A.__________________________________________ High School________ College_______

      B.__________________________________________ High School________ College_______

      C.__________________________________________ High School________ College_______

      D.__________________________________________ High School________ College_______

14. What is your grade point average? High School _________________ College________________

15. Have you applied for, or do you hold any other scholarships??
      Yes________ No________ If so, list them by name:____________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________  

16. What are your goals for the next academic year??

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

17.  While the primary consideration of the COMS faculty in awarding an academic scholarship is "scholarship," the scholarship committee would be interested in knowing the nature of your financial needs should you wish to share this information.

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

18. Please attach the following to this application::
      A. A copy of your academic transcripts _________
      B. Two sealed letters of recommendataion _________
      C. Both A & B have been previously submitted to the Department and are on file ________

19. Return these items to: Scholarship Committee Chairman
                                       Department of Communication Sciences and Disorders
                                       P.O. Box 42577
                                       Denton, TX 76204-5737.