Name (First,Last,Middle)*Student ID #Primary Phone #*Street Address*Alternate Phone #2nd Phone #City/State Zip*Your Email Address Other Email Address Date Of Birth GenderMaleFemaleOtherPrefer Not To DiscloseAre you currently enrolled?If no, I plan to enroll for: Fall/Spring/OtherYearWhere? Please Indicate Dates Attended BelowWinterYearSpringYearSummerYear EDUCATION : Please list all high schools, colleges and vocational-technical schools previously attended and/or at which you are currently enrolled. SchoolLocationDates AttendedField of StudyGPAGraduation Date/DegreeSchoolLocationDates AttendedField of StudyGPAGraduation Date/DegreeEXTRACURRICULAR ACTIVITIES :Please list educational achievements, organizational affiliations, community services, and volunteer activities – including any offices held.Please list leadership positions held; include all honors and awards received within the past five years.Please list your hobbies, talents and personal interests.Please list any additional information or special circumstances that you feel will assist the Scholarship Committee in making their decision. This is your opportunity to tell us something about yourself. You may want to include your work history.NameAvailable Student ID NumberThe proposed title of your paperDescribe the topic of your paper (it must explore a facet of Pleneurethics)Are you currently receiving financial aid?YesNoAttach Supplemental Documents Here Drop files here or PLEASE SEND ANY QUESTIONS TO THE PLENEURETHICS SOCIETY COORDINATOR: Jennifer Hensley 6501 S. 19th Street, Building 19 Room 65 (253) 625-0297 / jhensley924@gmail.com
