Application For The
PAUL B. PATTERSON SCHOLARSHIP
RETURN TO: The Scholarship Committee
Department of Mathematical Sciences
Appalachian State University
Boone, NC 28608
Also have high school transcript sent to the above address.
BY: March 25
Date of Application _____________ Social Sec. Number ___________________
Full Name: _____________________________________________________________
Address: _______________________________________________________________
Phone Number: ____________________ Date of Birth: ______________________
High School: ___________________________________________________________
Address: _______________________________________________________________
Date of expected graduation: ____________________
Home town newspaper: ___________________________________________________
Address: _______________________________________________________________
Parents or guardians: __________________________________________________
Address: _______________________________________________________________
Phone Number:___________________________________________________________
Give the name and address of the high school mathematics teacher you
plan to have submit a letter of recommendation.
________________________________________________________________________
________________________________________________________________________
Give the name and address of two other individuals who can be written
for recommendations.
________________________________________________________________________
________________________________________________________________________
Date you plan to enroll at ASU: ________________________________________
Have you received notice of acceptance to ASU? Yes_____ No_____
List your high school extra curricular activities and honors.
Make a statement regarding your career plans in mathematics.
Signature: ___________________________________ Date: ___________________