Gallaudet University
The Center of Academic Programs and Student Services (CAPSS)

CAPSS > Office for Students with Disabilities > Forms

Newcombe Scholarship Application Form

Print a hard copy and submit by mail, fax or in person.

Last Name: 

First: 

Middle: 

Address or PO Box: 

 

Campus Mail Address: 

Gallaudet ID: 

E-mail Address: 

Type of Disability: 

How did you hear from the Charlotte W. Newcombe scholarship?

 

Have you ever applied for a Charlotte W. Newcombe Scholarship before?

 

Yes

No
 

1. EDUCATION

List the secondary schools, colleges, training institutions, universities, etc., you have attended.  List the most recent institution first.  Do not list the institution in which you are presently enrolled.

1. Name of Institution: 

City, State and County:

Course of Study: 

Degree or Certificate:

Dates of attendance: 

From

To

 
 

2. Name of Institution: 

City, State and County:

Course of Study: 

Degree or Certificate:

Dates of attendance: 

From

To

 
 

3. Name of Institution:

City, State and County:

Course of Study: 

Degree or Certificate:

Dates of attendance: 

From

To

 
 

List any academic awards or honors you have received.  (Give name of Institution)

2. COLLEGE STATUS, PRESENT COURSE OF STUDY AND CAREER COALS

College Status:

State your major course of study and the degree you are pursuing:

Why did you choose this major?

What is your career goal?

Date of enrollment:   Full time student: Yes   No

If you are a part-time student, for how many hours are you enrolled?

How many credits does our Institution require for the degree you are pursuing?

How many credits will you have by fall 2006?

What other requirements will remain after fall 2006?

What is your current GPA (cumulative)

When do you plan to get your degree or certificate? Month Year

If a thesis or dissertations is included among the requirements that will remain after fall 2006, describe the content briefly.  Give title, if possible.  If it will include field of research, explain where and when you will do it.  Include a schedule for completing the thesis or dissertation. (please do not exceed 200 words).

Explain your career goals. (please do not exceed 200 words).

Sources of Funds

Estimated Amounts

(Such as: loans, personal savings, contributions from family members, on-campus or off campus employment, fellowships, grants teaching or research assistance, etc.)

$

$

$

$

   

Total 

$

   
   

Please explain "Other" estimated expenses if the total is 10% or more of your total estimated expenses. 

If your estimated expenses shown on the previous page exceeds the estimated amounts available to you, please explain how you plan to make up the deficit.

If you have applied elsewhere for a grant, or plan to do so, please indicate the source and amount.  Applications to other funding sources will not exclude you from consideration for a CNF scholarship.

 

3.  USE OF CNF SCHOLARSHIP AWARDS

CNF scholarship awards are in amounts up to $2,000.  Explain how you would spend such a grant and over what period of time.  Be specific as possible.  Scholarship awards may not be used to repay loans. (please do not exceed 200 words).

4. COMMUNITY SERVICE

Describe community service in which you have engaged for which you were not paid.  List the most recent first.

1. Agency or Institution:

City, State, and Country:

Dates of Service:

Description of Responsibilities:

 

2. Agency or Institution:

City, State, and Country:

Dates of Service:

Description of Responsibilities:

5.  ESSAY

To assist the Selection Panel getting to know you better as a person, write an essay, introducing yourself.

Where did you grow up?  In a city?  In a rural area? Was access to schooling difficult for you?  Was it easy? Who were some of the persons who were influential in your life?  What are your interests other than academic? Any other important information may be added.  (Please limit your essay to 500 words or less).

Thank You.

For more information or assistance, contact:

College of Liberal Arts, Sciences, and Technologies
Center for Academic Programs and Student Services (CAPSS)
Gallaudet University   Office for Students With Disabilities
Student Academic Center Room 1220
800 Florida Ave. NE
Washington, D.C.20002-3659
(202) 651-5256 (V/TTY)
oswd@gallaudet.edu