Salutation:   Mr.   Ms.   Mrs.              Sex:   Male   Female

Last Name: First Name: Middle Name:

Thiel College ID Number:

Permanent Home Address:

Address Line 1:

Address Line 2:

City: County: State: AK AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY AE AA AP Zip Code:

Phone Number:

Student Email Address:

Parent Email Address:

High School: City: State: AL AK AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY AE AA AP Zip Code:

Housing Status:   On - Campus    Off - Campus (Independent student)   Commuter (Living with parents)

Will you be applying for need based aid (FAFSA):   Yes   No

What is your expected graduation year: Current Academic Year: 2009 2010 2011 and Term: Fall Spring Summer

If you anticipate receiving outside scholarship for the 2010-2011 Academic Year, please list the names and anticipated amount of each. Do not include Pell Grant or State Grants.

List your academic Major(s) and Minor(s):

What are your career plans:

Thiel College makes special recognition scholarships and other merit awards based upon a range of criteria, including academic performance; leadership; involvement in student activities, organizations and performing arts; church and/or youth ministry participation; and community service.

Please list your student activities, clubs, sports, organizations and community service:

Specific Information

Some scholarships have very specific requirements. If you want to be considered for one of these and meet one of the following criteria, please provide the appropriate information.

What is your religious preference:

Are you an active member of ELCA congregation (please specify):

Do you have a parent who is an active pastor in ELCA church:

Do you have a parent, grandparent or sibling who
is an alumnus(a) of Thiel College (please specify):

Do you have a sibling currently attending Thiel College
on a full-time basis.(Name):

Are you a member of a Minority (please specify):

Do you intend to study abroad next academic year (please specify where):

Are you a Descendent of: Please Select Mary and Thomas Callen Eleanor D. Eakin John T. Egbert Chase Laundry & Dry Cleaning Employee

Do you have a parent who is a law enforcement officer in Allegheny County:

Are you from Greek Ancestry:

Are you an employee or dependent of employee of Joy Cone Company:

Do you participate in the Thiel Honors Program:

Do you have serious intent to pursue a Law Degree:

Please submit this form no later than March 21, 2010 to be considered for any institutional scholarships.