Don and Barbara Curtis Excellence Fund for Extracurricular Activities (F:29201, S:J0092)
Cole Campbell Professional Development Fund (F:29910, S:J0103)
Patricia Miller Moore Award (F:29920, S:J0110)

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* 1. Legal Name (LAST, FIRST, MIDDLE)

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* 2. PID

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* 3. Email

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* 4. Mobile phone

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* 5. Permanent address (Street, City, State, Zip code)

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* 6. Expected graduation date

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* 7. MJ-school GPA

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* 8. Overall GPA

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* 9. MJ-school specialization or area of study

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* 10. Name of activity, conference, etc.

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* 11. Activity/conference dates

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* 12. Activity/conference location

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* 13. Description of proposed activity and what you hope to gain from it. (Please limit response to no more than six lines.)

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* 14. Budget ($1,000 maximum--Provide details on how you will use the funds.)

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* 15. I will use funds awarded for the sole purpose described and will notify the MJ-school immediately if my plans change. Awards may have tax implications. Only undergraduate majors admitted to the MJ-school are eligible to apply.

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* 16. Please upload a copy of your OneCard (PDF or JPEG).

PDF, JPG, JPEG file types only.
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