ROBERT H. MEYNE

MEMORIAL SCHOLARSHIP

APPLICATION FORM

NAME______________________________________________________SSN_____________________________

CAMPUS ADDRESS/PHONE____________________________________________________________________

NO. OF HOURS EARNED AT ISU_________________ CUM. G.P.A.______________

PROFESSIONAL ORGANIZATIONS:

A. MEMBERSHIPS

B. ACTIVITIES (Committees, Offices held, Conferences)

RECREATION LEADERSHIP EXPERIENCE:

DATES AGENCY LEADERSHIP EXPERIENCE

SOURCES OF FINANCING YOUR EDUCATION:

I understand that in addition to the above requirements, I will be enrolled in both semesters of the 2007-2008

academic year. Should I not be a student in both semesters, I will forfeit the scholarship for one or both semesters.

________________________________________

Signature

DEADLINE FOR APPLICATION: DECEMBER 17, 2006