David Gall Memorial Scholarship Application

Application Deadline: June 30th

A. STUDENT INFORMATION

First Name: _______________________ Last Name: _______________________ MI: ______________

Address: _________________________ City: ____________________ State: ___________ Zip: _______

Phone: ___________________________ University Email: _____________________________________

University ID number ___________________________________________________________________

B. EDUCATIONAL INFORMATION

What OTC College/University have you been accepted to for the upcoming fall semester?Please provide the mailing address of the Office of the Bursar (Business Office) at your intended institution.List the Major(s) you have been approved to pursue at your transfer institution.Class Level as of August 1st

Expected Date of Graduation

Please list all the colleges and universities that you have attended. Please start with your current institution.

Institution & Location Dates Attended Area of Study/Degree Earned

C. EMPLOYMENT HISTORY

Current Employment ☐ Full-Time ☐ Part-Time ☐ Not Working

Previous Employer Month/Year City, State Telephone Number

D. ESSAY GUIDELINES

Examine and clarify your short and long term educational goals in a typed, double spaced, 500-word essay. Your essay should also include:

What led to your decision to transfer schools? What major will you pursue and why? Information regarding any community service you have been involved with since

starting college. Information on how you plan on being an engaged transfer student at your new

institution. How will this scholarship assist you in your academic goals?

E. SIGNATURE AND PERMISSION FOR RELEASE OF INFORMATION

I certify that all statements in this application are true and correct. Furthermore, I grant permission for the Ohio Transfer Council to request information from all prior, current, and intended institutions pertaining to my academic record. I understand that a minimum 6 credit hour registration and a minimum grade point average of 3.0 are required in order to maintain my scholarship eligibility.

Print Name Signature Date

Website Consent:

If selected for the scholarship, I agree to allow the Ohio Transfer Council to post my name and transfer institution information on the OTC website.

Print Name Signature Date

Mail this completed packet, a letter of recommendation, and Official Transcripts to:

Donna P. GeraciOffice of the RegistrarXavier University3800 Victory ParkwayCincinnati, OH 45207-3351

On behalf of the Ohio Transfer Council, thank you for applying. Please insure all materials are forwarded together, and retain a copy of the application materials as the original documents cannot be returned. All applicants will be notified by email around August 1st.