Instructions:  All Sections must be completed.  Attach endorsement letters,  transcripts and/or certificate of work in progress.  After completion click on the Print Form .to print this application.  Then go to, Print and Attach blank Committee Action Report .

Submission Date: ______________________

Date received by Scholarship Chair:  ______________________

1.  Personal Data:

Name:

129th RQW Unit Assignment:

Rank:                 AFSC:

129th RQW Service Dates:   to: 

Home Address:    Apt #: 

City:     State:   Zip Code:

Phone: ()    E-Mail:

2.  Educational Source Data:

Institution Name:

Location:

Course Type :   4 Year College,       Community College,       Vocational School

Major Career Interest:

Why did you choose this educational resource and your major:

3.  School and Community Activities:  (List clubs, committees, volunteer work, organizational offices you have held, and special achievements.)

4.  Civilian Employment: (List work assignments, supervisory assignments, and special work experiences.)

5.  Personal Statement: (Discuss how you plan to apply your educational accomplishments to your professional/ career goals - both civilian and military.)

Date Completed: ______________________________________________________

Signature: ___________________________________________________________

Submission Instructions:  The completed application must be submitted to Lt Col Cynthia Kepple, Scholarship Chair for the 129th Alumni & Heritage Association, by the November drill weekend.  A letter of endorsement from your commanding officer must accompany the application.  A current transcript, a statement of work in progress from the educational facility or other evidence of program participation is required and must be attached. If any applicant's contact information changes, it is the applicant's responsibility to notify the Scholarship Committee Chair immediately.