Epsilon Chapter Alumni Association
of Theta Chi Fraternity
85 Salisbury Street
Worcester, MA 01609
http://oxepsilon.org
scholarship (at) oxepsilon (dot) org

Application for the

2008 Epsilon Chapter Scholarship for
Outstanding Community Service

Applicant’s Name		Date
Permanent Address
City/State/Zip Code
Home Phone
Home E-mail address
Parent’s Name(s) (Either or both – optional)
Parent’s Home Address
Parent’s Home Phone		Cell Phone
Hometown Newspaper/Address

Applicant's Contact Information

WPI residence
WPI Phone No		Cell Phone
WPI e-mail address
Other Contact Information (optional)
Declared or Intended WPI Major

Information for the Scholarship Committee

Please describe community activities with which you have been involved or have led. Feel free to attach a resume or any other supporting information you would like the committee to consider.

Please list any of your high/preparatory school activities (clubs, sports, offices and awards) you would like the committee to consider, or attach a resume.

Please list any employment experience having a community-service aspect.

Please provide the name, with contact information, of a person who will provide a letter of recommendation in support of your application for the scholarship award. This reference might be a teacher, guidance counselor, or school administrator, or a leader in a community organization with which you have been involved. It will be the applicant’s responsibility to insure that the recommendation letter is submitted electronically or postmarked by Friday September 26, 2008.

Name of Reference:

Mailing Address:

Phone and E-mail Address:

Affiliation (school, organization, etc.):

Essay Requirement

On a separate sheet, in about 200-300 words, please type an essay describing your educational and career goals as you see them upon entering your freshman year at WPI. Feel free to include any pertinent information that you feel would be useful to the scholarship committee in evaluating your application.

Summary of items to be submitted

In order for the scholarship committee to consider your application, all of the following items must be submitted electronically or postmarked by Friday September 26, 2008. If the letter of recommendation is to be sent directly to the committee, you must make note of this on your application. Incomplete or late applications will be declined.

Completed scholarship application form (previous pages) with any supporting information.
Applicant’s one-page essay.
Letter of recommendation (may be included with this application or sent directly to the committee)
Dated signatures of applicant and parent or guardian (below).

Signatures

Applicant’s Signature		Date
Parent/Guardian Signature		Date

Please send your completed application and all supporting information, either electronically, or by mail postmarked no later than 11:59 PM, Friday September 26, 2008 to: