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)

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

* 2. PID

* 3. Email

* 4. Mobile phone

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

* 6. Expected graduation date

* 7. MJ-school GPA

* 8. Overall GPA

* 9. MJ-school specialization or area of study

* 10. Name of activity, conference, etc.

* 11. Activity/conference dates

* 12. Activity/conference location

* 13. Description of proposed activity and what you hope to gain from it.  (Please limit response to no more than 6 lines.)

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

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

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

PDF, JPG, JPEG file types only.
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