Tropical Ecology Scholarship Form

To be completed only by those students who require financial assistance to enable their participation in the Tropical Ecology class

Name of Applicant:________________________________________________________

Address:________________________________________________________________

Telephone #: ______________________________

Major:____________________________ GPA _____________

Minimum amount needed of scholarship in order to participate in program $________

Please type or neatly write the answers to the following questions on the reverse side or on a separate sheet of paper.

1) What special background or interests do you have that would make participation in this course especially worthwhile for you?

2) Describe your educational objectives and long term goals.

3) Please give reasons why you feel that you should be considered for this scholarship.

I grant permission to Mission College Admissions and Records department to release information about my GPA for the purposes of applying for this scholarship

________________________________________ _________________

signature date

If selected as a scholarship recipient, I am willing to make presentations about my experiences in Costa Rica to students, faculty and administrators and to assist in the promotion of this program on campus.

________________________________________ _________________

signature date

I grant permission to the financial aid office to release my financial aid file for the purposes of applying for this scholarship

________________________________________ _________________

signature date

Please return your completed form to:

Jean Replicon (408) 855-5267

Biological Sciences Dept mailstop #17

Mission College

3000 Mission College Blvd.

Santa Clara, CA 95054