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GENE AND ANNE WILSON ENDOWED THEATRE SCHOLARSHIP

Year for Scholarship/Award Application Form:
First name:
Last name:
Local Address:
Phone:
Permanent Home Address:
Major or Minor:
Major/Minor Credits Completed:
Theatre Major/Minor GPA:
Total Credits Completed:
Cumulative Grade Point Average:
Class Status:
Accepted to Graduate School (For graduating seniors)
Graduate School attending in the fall:

List chronologically (from earliest to current) the type of participation in production activities of the department:

Production	Role/Responsibility	Date

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List chronologically (from earliest to current) elected positions in UW-Whitewater organizations or major committees. Please place a star (*) in front any group which is an honorary society.

Name of Group	Office Elected to	Dates of Service

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List chronological the UW-Whitewater organizations, extra-curricular activities, major committees, etc. in which you participated in and/or held membership. Place a star (*) in front of any group which is an honorary society.

Group Name	Membership/Participation Dates	Activities/Participation Nature

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Add any information or comments that you feel may be significant to your selection for a scholarship or award.