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The Siegfried and Ellen Karsten Scholarship

Scholarship Application Form

Please submit this application form and all other supporting documents to Jennifer Larson, Division of Child and Family

Services, 195 N 1950 W Salt Lake City, UT 84114 by April 1 for Fall semester and October 1 for Spring semester to ensure

that you are fully considered. Applications can be mailed to address above, or faxed to (801)538-3993 or emailed to

scholarship.

2. Transcripts: Please include a copy of your transcripts (high school for freshman applicants and college for transfer

or continuing applicants).

3. ACT Scores/Accuplacer Exam: (for incoming freshman) First year students will need to submit testing scores. If

students take the Accuplacer exam, tests scores will be forwarded to the scholarship committee.

4. Eligibility: The Division of Child and Family Services must provide a letter certifying your eligibility for the

scholarship. To receive verification of foster care status, please contact Jennifer Larson, Adolescent Services

Program Administrator (801) 707-9734 or jblarson@utah.gov

5. Letters of Recommendation: One or more letters of recommendation from someone who knows you and who can

address your academic promise, maturity and perseverance (such as a teacher, counselor, caseworker, employer, or

Will you be applying to enter the U of U as a: ______Freshman ______Transfer ______Continuing Student?

Name: ______________________________________________________________________________ Gender: _______________

Address: ___________________________________________________ City, State, and Zip Code: _____________________________________

Home Phone: ____________________________ Other Phone: ____________________________ Emergency Phone: ___________________________

E-mail Address: _______________________________________________________________________________________

List of College Activities: ___________________________________________________________________________________________________

High School Grade Point Average (Freshman): ___________ Transfer GPA: ___________ U of U GPA: ___________

ACT or SAT Composite Score: ______________ Number of College credit hours earned (if applicable): _________________

Advanced Placement courses taken (if applicable): __________________________

Honor course taken (if applicable): ______________________________________________________________________________

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It is mandatory that applicants apply for federal financial aid online at http://www.fafsa.ed.gov/ or call the Financial Aid

office at 801-581-6211 for more information.

Students who receive a scholarship, fellowship, or other financial aid administered by the University of Utah are required by

state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another country who is

lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should seek the advice of an

immigration attorney before filing a scholarship/financial aid application.

Prior to the disbursement of any scholarship/financial aid, the University of Utah is required by law to verify the recipient’s

I certify that the information provided in this form is true to the best of my knowledge. I authorize the University of Utah to

release any materials or information submitted with this application (including: application, official transcript(s), personal

statement/essay, and supporting documentation) to any individual, organization, or committee related to the scholarship

selection process. I understand that my lawful presence within the U.S. will be verified through the Department of

Homeland Security prior to an award of this scholarship/financial aid.

_____________________________________________________________________________________________________________

225 S. 1400 E., Room 228

Salt Lake City, UT 84112

Phone (801) 581-6521

Fax (801) 581-5156

[email protected].edu