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2320 Buzzard Hall
600 Lincoln Avenue
Charleston, IL 61920
Phone: 217-581-2919
Fax: 217-581-6673
Email: edadmin@eiu.edu

Office Hours

Monday - Friday: 8:00 am - 4:30 pm

2012 Scholarship Application Form

Department of Educational Leadership, Eastern Illinois University

Scholarship Applications and all supporting documentation is due by Monday, March 26, 2012

Name * First Last
E Number *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone * - (###) - ### ####
Cell Phone - (###) - ### ####
Work Phone - (###) - ### ####
EIU Email Address (required) *
On or Off Campus Student? *
If you selected Off Campus Student above, which cohort do you belong to?
Number of hours completed at the end of the Spring 2012 semester? *
Will you be enrolled for the Fall 2012 semester? *
Please check the scholarship(s) for which you are applying . Although, you may apply for more than one scholarship, selected recipients will only receive one (1) award. For Scholarship Criteria please visit the Educational Leadership Website at www.eiu.edu/~edadmin/scholarships.php. * John and Joyce Dively Educational Leadership Scholarship The Rohn Family Scholarship in Education Administration Hans C. Olsen Scholarship Warner Educational Administration Scholarship CEPS Telefund Scholarship
Your application is almost complete. Please send supporting documentation to the department by mail, fax or email. Types of supporting documentation include Resumes, Letters of Recommendation, Personal Letters, etc. Anything that can show that reflects how one meet the requirements for the award. No limit as to how many documents one may submit.

Mailing address: The Department of Educational Leadership, Eastern Illinois University, 2320 Buzzard Hall, 600 Lincoln Avenue, Charleston, IL 61920

Fax number: 217-581-6673

E-mail documentation to: Shannon Schwab, Office Manager at syschwab@eiu.edu

I understand that to be considered for a scholarship that I must submit supporting documentation as to how I meet the criteria for the selected award. If my documentation isn't submitted by the deadline (March 26, 2012), I understand that my application will not be considered. * First Last

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2012 Scholarship Application Form

2012 Scholarship Application Form