Please print this form and return it using the US Postal Service:

IAHPERD
IOWA ASSOCIATION FOR
HEALTH - PHYSICAL EDUCATION - RECREATION - DANCE
Scholarship Application Form

Requirements: The applicant must be an undergraduate student who is planning to enter the Physical Education, Health , Recreation, or Dance profession. Applicant must be of at least a sophomore standing, enrolled in an Iowa college or university and have a current GPA of at least 2.5. The student should be involved in student activities and professional organizations. Application deadline is March 8, 2002.

Personal Data

Name:

________________ ________________ _____________________ ___________
(Last) (First) (College) (Year in School)
Home Address:
________________ ________________ ________________ ___________ ________________
(Street) (City) (State) (Zip) (Telephone)
College Address:
________________ ________________ ________________ ___________ ________________
(Street) (City) (State) (Zip) (Telephone)

Major:_____________________ Minor:_____________________
E-mail: ____________________ Student ID Number: __________ Social Security Number: __________
Expected semester and year of graduation: ____________________________________________

Activities: List college and community organizations and activities, including volunteer services.

Organization: Dates of Involvement:
__________________________ ______________
__________________________ ______________
__________________________ ______________

Are you currently a member of IAHPERD?______________
Other Professional Organizations? (List each)__________________________________________

Honors: List any honors which you have received.

Honor: Date Received:
__________________________ ______________
__________________________ ______________
__________________________ ______________

Employment: List any full or part time work experience you have had during the past three years .

Type: Agency: Hours/Week: Dates:
_______________ _______________ _______________ _______________
_______________ _______________ _______________ _______________
_______________ _______________ _______________ _______________

SCHOLARSHIPS, GRANTS, WORK STUDY, LOANS, ETC.: List any of these awards which you are currently receiving .

Title: Amount: Mo./Year of Expiration:
________________ ________________ ________________
________________ ________________ ________________
________________ ________________ ________________
________________ ________________ ________________
________________ ________________ ________________
Financial Need: Estimate percentages of these categories from which you receive money.
___________ Parents _________ Employment or other self supporting means
__________ Grants, Scholarship, etc., ___________ Loan (s) ________ Other Considerations( Specify):_____________

How many siblings are presently in college or will be in college next year? _________
If you are awarded a scholarship, what is the name and address of your Hometown Newspaper(s) where the announcement should be sent?
Name(s)____________________________________________________________
address(es):_________________________________________________________________________

Name and address of Principal and High School from which you graduated:
__________________________________________________________________________________

Supporting Material - To be considered, all applicants must also submit the following:

  1. Letter written by you, stating clearly your qualifications for the scholarship for which you are applying. In this letter, describe your plans for a career in your specific area of interest. (Health education, recreation, physical education, dance, intramural, athletic training, or other).
  2. Official transcript of college credits
  3. Three letters of recommendation. One from a major professor, another from a member of the faculty other than the major department, and one from a source not associated with your college/university.
I hereby certify that the information completed is accurate to the best of my knowledge and authorize the Scholarship committee to use and reprint any information stated above as they deem necessary for the scholarship determination.

Signature _______________________________________________ Date: ____________________
This application form must be filled out in full and mailed by the applicant with attached letter, transcript, and the three letters of recommendation to:

Dr. Rip Marston
IAHPERD Scholarship Chair
119 WRC
University of Northern Iowa
Cedar Falls, Iowa

319/; E-mail =
This application and other supporting materials must be postmarked no later than March 8, 2002