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Calvin College Graduate Studies

Graduate Studies in Education Scholarship Application Form

This form is to be used by students in the MEd program. Please complete this form and request two professionals to complete the Graduate Scholarship Recommendation Form. Your professional references should be from persons who can comment on your teaching or coursework. This application and your two references must be received by the Graduate Studies in Education Program Office no later than March 1, 2015.

First Name
Last Name
Street Address 1
Street Address 2
City       State      Country      Zip 
Complete Email Address
Calvin ID#
Cumulative Graduate GPA            Undergraduate GPA
Undergraduate college or university
List the courses you plan to take at Calvin over the next academic year. Please be as accurate as you can on which courses you will be taking in the 2015-2016 school year. Include summer 2015 courses if planned. Try to indicate a minimum of 2 courses. (List course number and name.)
Course 1
Course 2
Course 3
Course 4
Course 5
Describe each teaching position held. Include the school system, location, and years you held each postion. (You may copy and paste from a Word document.)
Please check the scholarships you are applying for:
Art & Marilyn Dykstra Mary Louise Huizenga
Corrine Kass Fred & Carol Van Den Bosch
Keeping in mind the specific criteria, describe your qualifications for the scholarship(s) for which you are applying.
Does your place of employment provide you with tuition assistance for your program of study?      If yes, how much?
What is your current household size (include spouse, children, and any others that you financially support within the home)?
How many are in your immediate family (you, your spouse and children only)?
How many of your dependents are currently in school (P-12)?
Are you currently paying Christian school tuition for them?
If yes, how much annually?
What is your total adjusted gross income for 2014?
Describe any financial circumstances that you would like the committee to consider:
Please provide the names and email addresses of your professional references:

Ref. 1 Name Email

Ref. 2 Name Email

According to law, a student may waive his/her right to examine any document in his/her file. Failure to waive will not be prejudicial to the student. By checking this box I waive all rights of access to the recommendation materials.
By checking this box, I authorize the Graduate Studies in Education Program Office to share with official organizations information about my college record that is necessary to determine eligibility for the scholarships and to release this information to this scholarship’s donor. I also authorize the Calvin College Graduate Studies in Education Program Office to discuss my capacities for graduate study with those who will be submitting professional references for your scholarship application.