Iindependent Unniversity Alumni Association at Lowell

Independent University Alumni Association at Lowell Scholarships
Alumni Memorial Library
P.O. Box 242
Lowell, MA 01853-2881
999.999.9999

Scholarship Application
Name:
Student ID No.:	- -
Address 1:
Address 2:
City:
State:	Zip:
Phone:
University Address:
Marital Status:	Single Married Separated Divorced
U.S. Citizen Student Visa Permanent Resident I.D. No.
Freshman Sophmore Junior Senior Grad. Student
Major Field:
Academic Reference Position:
List Honors, grants or scholarships:
List Financial Assistance and Other Sources of Income:
Reason for Request:
College transcripts must be submitted to the Alumni Association Office. Freshman submit high school transcripts and SAT scores.
Math: Enlish: Cumulative Standing:
Applicant's Signature: Date:
Please return to the address at the top of the page. Attention of the scholarship committee. Return applications no later than November 23, 2011. This Scholarship may affect your financial package Please direct any questions to the Financial Aid Office.