ALUMNI ASSOCIATION REGIONAL SCHOLARSHIP

Scholarship Purpose: The Dordt University Alumni Association wishes to encourage incoming freshmen students who want to receive a Christian higher education degree at Dordt University. It is the Alumni Association’s desire that these recipients fully appreciate the mission of Dordt University.Scholarship Eligibility: Any incoming freshman student accepted for admission at Dordt University who has a 2.80 minimum cumulative grade point average is eligible to apply for these scholarships.Scholarship Awards: Forty scholarships will be awarded. Whenever possible at least one recipient will be selected from each of the alumni geographic regions.

Region 1: Within 100 miles of Dordt University, South Dakota Region 2: Minnesota, North DakotaRegion 3: Iowa, Nebraska, Missouri, Oklahoma, Arkansas, Louisiana Region 4: California, Nevada, Alaska, HawaiiRegion 5: Arizona, New Mexico, TexasRegion 6: MichiganRegion 7: WisconsinRegion 8: Illinois, IndianaRegion 9: Oregon, WashingtonRegion 10: Idaho, MontanaRegion 11: Colorado, Kansas, Utah, WyomingRegion 12: British ColombiaRegion 13: Alberta, Saskatchewan, ManitobaRegion 14: Ontario, Eastern CanadaRegion 15: Eastern United States, Other Countries

Application Procedure:1. Complete this application form.2. Complete the Office of Admissions application process and be accepted for admission to Dordt

University.3. Ask one of our Dordt University alumni to complete the attached reference form. If there are no

alumni available to write the reference, you may request someone who understands the mission of Dordt University to complete the form. Your reference writer should know you well but should not be a close relative.

4. The application form and reference form must be postmarked or sent by December 1 to one of the following addresses:Mail to: Scholarships Office

Dordt University700 7th St NESioux Center, IA 51250

Email: schowork@dordt.eduFax: 712.722.6035 — Attn: Scholarships Office

Alumni Association Regional Scholarships

DORDT UNIVERSITY

ALUMNI ASSOCIATION REGIONAL SCHOLARSHIP APPLICATION FORM

Name: _________________________________________________________________________________________Last Name First Name Middle Initial

Address: ________________________________________________________________________________________Street/Rural Route

_______________________________________________________________________________________City State/Province Zip/Postal Code

Telephone: (_____) ___________ - ___________________ Gender: Male Female

Parent’s Name: ___________________________________________________________________________________

High School Name: _______________________________________________________________________________

Name of person writing your reference form: ___________________________________________________________

Write an essay telling how you came to know about Dordt University and why you want to be a Dordt University student. Your essay should be 250-500 words, printed and double spaced.

Signature: _____________________________________________________________ Date: ____________________

Applicant’s Name _____________________________

Applicant InstructionsAsk one of our Dordt University alumni to complete this reference form. If there are no alumni available to write the reference, you may request someone who understands the mission of Dordt University to complete the form. Your reference writer should know you well but should not be a close relative. Along with the reference form, give your writer a stamped envelope on which you have written the address listed below, so that the reference form can be sent directly to the Financial Aid Office of Scholarships. Also inform the writer of the December 1 postmark deadline date.

Reference Writer InstructionsThe Dordt University Alumni Association wishes to encourage incoming freshmen student who want to receive a Christian higher education degree at Dordt University. It is the Alumni Association’s desire that these recipients fully appreciate the mission of Dordt University. Any incoming freshman student accepted for admission at Dordt University who has a 2.8 minimum cumulative grade point average is eligible to apply for these scholarships. Forty scholarships will be awarded. Whenever possible at least one recipient will be selected from each of the alumni geographic regions. The above named applicant is applying for a Dordt University Regional Alumni Scholarship. Along with the applicant’s application form and essay, the scholarship committee will be reading a reference written by you. Your recommendation will be very important to the scholarship committee as they make the final recipient decisions.Please complete this form for the applicant. If the applicant has not given you an addressed envelope, send the completed reference to one of the following addresses postmarked or sent by December 1.

Mail to: Scholarships Office Dordt University700 7th St NESioux Center, IA 51250

Email: schowork@dordt.eduFax: 712.722.6035 — Attn: Scholarships Office

Waiver of Applicant’s Rights:

According to law, a student may waive his or her right to examine any document in his or her file. Failure to waive will not be prejudical to the student.

By signing this statement, I, the applicant, waive all rights of access to this document.

____________________________________________ ________________________Student’s Signature Date

Alumni Association Regional ScholarshipsReference Form

DORDT UNIVERSITY

ALUMNI ASSOCIATION REGIONAL SCHOLARSHIP REFERENCE FORM

Applicant’s Name: ____________________________________________________________________________________________________

For how long and in what capacity have you known the applicant? ___________________________________________

_______________________________________________________________________________________________

Please rate the applicant as candidly as possible based upon the personal characteristics and code listed below. Circle the cor-rect number.

1 – Excellent 4 – Poor2 – Good 5 – No Evidence3 – Average

1. Christian Commitmenta. shows spiritual maturity 1 2 3 4 5 b. exhibits a consistent Christian lifestyle 1 2 3 4 5 c. speaks openly about personal Christian commitment 1 2 3 4 5

2. Maturitya. shows a sense of responsibility 1 2 3 4 5 b. works hard to do a job well 1 2 3 4 5 c. shows self-confidence 1 2 3 4 5

3. Interpersonal Relationsa. demonstrates genuine concern for others 1 2 3 4 5 b. relates to a broad spectrum of persons 1 2 3 4 5 c. communicates well 1 2 3 4 5

4. Leadershipa. shows strong leadership ability 1 2 3 4 5 b. wins enthusiastic support from others 1 2 3 4 5 c. respects opinions of others 1 2 3 4 5

Please write a recommendation of no more than 300 words, endorsing this applicant as a worthy recipient of a Dordt University Alumni Association Regional Scholarship. You may wish to expand on the applicant’s personal characteristics as listed above. Also consider explaining why you believe this applicant would benefit from attending Dordt University and/or why Dordt University would be promoted by the attendance of this applicant.

Signature: _____________________________________________________________ Date: ___________________

If you are a Dordt University alumnus (defined as having completed 24 credit hours) please indicate which years you attended Dordt University ________________________________________________________________________

Excellent No Evidence