William A. Smith Scholarship Application

Department of Recreation Administration - Eastern Illinois University

Name Name First Last
Date Date / MM / DD YYYY
Campus Address Campus Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Campus Phone Campus Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Permanent Phone Permanent Phone - ### - ### ####
Major
Number of Credit Hours Completed in Major
Major GPA
Cover Letter Upload (PDF or DOC)
Resume Upload (PDF or DOC)