Balanced Man Scholarship

(Application is to be typed or printed.)

Name:                                                                                                                                                                                                                 

Parent/Guardian Names:                                                                                                                                                            

Address:                                                                                                                                                                                             

City:                                                                                                       State:                                    Zip:                                       

Phone:  (              )                                                                              E-Mail:                                                                 

Birth Date:                                                                                          Graduation Date:                                                             

        Key Club Member

        Boy Scouts of America Member                                        Troop Number (if applicable)                                   

Scholastic Information Cumulative H.S. GPA (un-weighted, 4.0 scale):                                                  ACT/SAT:                                                            

Intended Major:                                                                                                                                                                              

High School:                                                                                                                                                                                      

Intended College or University:                                                                                                                                               

Leadership, Activities & Achievement Information On no more than three pages, address the following in outline form.  Be sure to include dates and positions held (if applicable):

§         List honors, awards, or scholarships.

§         List extracurricular activities and positions held.

§         List community involvement.

§         List work experience.

Should you have any questions, please call Morgan Maclin at Sigma Phi Epsilon Headquarters, 804.612.1393, or email bms@sigep.net.

Signature of Applicant:                                                                                                 Date:                                                    

*Return to the chapter's Balanced Man Scholarship Chairman or President. Check Mi Zeta E-Board for contact officers..