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* 1. What is your name: last, first?

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* 2. What is your permanent street address?

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* 3. What is a telephone number where you can be easily reached?

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* 4. What is your cumulative GPA at NDMU?

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* 5. In which school(s) are you completing your internship and what are you teaching?

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* 6. In which teacher preparation program are you enrolled?

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* 7. For what area(s) of certification are you preparing? Identify all that apply.

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* 8. Do you have a FAFSA form on file at the NDMU Office of Financial Aid?

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* 9. Do you commit to teach in Maryland?

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* 10. Please describe below any special hardship or situation that you have had to deal with or have resolved which demonstrates your unique need for this scholarship.

In addition to completing this online application you must submit, or ensure submission, of the following three (3) items:

1. A typed essay (350 words, double spaced) explaining ''How, as a teacher or intern, you were able to assess, prescribe and impact a student or group of students with whom you have worked. Describe this impact in terms of student achievement and learning goals. Please also provide a brief explanation as to why you are pursuing a career in teaching and why this scholarship is so important to your future. Submit this essay to Dr. Gary Thrift via email at gthrift@ndm.edu

2. A one-page resume. At the bottom of your resume, give the name, e-mail address and phone number of one of your field supervisors who is willing to serve as a reference for you.  Submit this resume to Dr. Gary Thrift via email at gthrift@ndm.edu 

3. The completed reference form from one of your mentor teachers. Send this reference form/link to your mentor teacher to complete online: https://www.surveymonkey.com/r/Spr2017Reference

The essay and resume must be submitted via email by 4:00 p.m., Friday March 10, 2017, to Dr. Gary L. Thrift, School of Education Chair, at gthrift@ndm.edu   Likewise, the online application and online reference must be completed by this same time.

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