Saluki Stay Scholarship Application

Saluki Stay
Scholarship Application
The Saluki Stay Scholarship is one of the most unique scholarship programs at SIU. Five scholarships will
be awarded, including in-kind gifts ranging from retail store gift cards and assistance with utility bills to
meals in area restaurants. The total value of the awards is approximately $1,500 each.
The Saluki Stay Scholarship award will be given to a Junior or Senior who has been enrolled at full time
status at SIU for the last two years. The student must have at least a 2.8 GPA (A=4.0), be enrolled full
time for fall semester classes and be employed by a current Carbondale Chamber of Commerce
member. Preference will be given to students with financial need. Please contact the Chamber office
for a list of current Chamber members.
To be considered for this award, applicants must submit this application by April 30, 2015. Awardees
will be notified by May 1. Scholarship items will be awarded at the Carbondale Chamber of Commerce
Luncheon on August 18, 2015. Scholarship winners are required to attend.
Please TYPE the following information, then PRINT, SIGN and EMAIL or FAX the completed application.
Legal Name
(Last)
Permanent Street Address
(First)
(Middle)
City, State, Zip Code
Area Code and Telephone Number
Local Street Address
SIU Cumulative GPA
Dawg Tag Number
County
Email Address
City, State Zip Code
County
Are you applying as a Junior or Senior?
What is your intended major or area of study? ______________________________________________
Awards: List awards, honors, or special recognitions you received during college. Additional
information may be listed on a separate sheet of paper.
Extra Curricular Activities: List school activities and community services in which you have
participated. Indicate leadership positions held (if any).
References:
Explain your career aspirations and college goals and how you expect to meet those goals by
attending Southern Illinois University in Carbondale.
Please indicate the name of the Carbondale Chamber of Commerce member business by which you
are employed.
List any other scholarships that you will receive (please include the value per year for each
scholarship).
Applicants must also submit, on a separate sheet of paper, a 500 word essay on
why they feel they are deserving of the Saluki Stay Scholarship.
All Applicants Must Complete This Section
I accept the conditions of the award described in this application. I signify that the information
supplied for admission to Southern Illinois University is true and accurate, to the best of my
knowledge. Further, I understand my obligation to notify SIU and the Carbondale Chamber of
Commerce in writing as soon as possible if I modify my decision to enroll. I understand my obligation
to notify SIU and the Carbondale Chamber of Commerce in writing as soon as possible if I am no longer
employed by a member business of the Carbondale Chamber of Commerce. As a recipient of an
academic scholarship from the Carbondale Chamber of Commerce, I understand that the University
and the Carbondale Chamber of Commerce has the legal authority to release my name and address,
the name of my former high school or college, the name of my award, and the award amount. I also
realize there will be events in the community that I will be contacted about in regards to for
participation. This release is valid for the period of time the scholarship is in effect.
_____________________________________
Signature of Applicant
Please Return This Application To:
Les O’Dell
131 S. Illinois Ave.
Carbondale, IL 62901
Ph: 618-549-2146
Fax: 618-529-5063
Email: info@carbondalechamber.com
_____________________________________
Date