| Due Date: December 1 |
| * Designates Mandatory Field |
| Applicant Personal Background |
| * Last Name: |
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| * First Name: |
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| * Email Address: |
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| Social Security #: |
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| Chapter/Grad Year: |
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| Years in School: |
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| Proj. Grad Date: |
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| Home Phone: |
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| School Phone: |
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| * School Address: |
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| * City: |
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| * State: |
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| * Zip: |
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| Effective Until: |
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| Date of Birth: |
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| * Permanent Address: |
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| * City |
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| * State |
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| * Zip |
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| Academic Background (send a certified current transcript) |
| Major: |
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| Minors: |
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| GPA Overall: |
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| What have been your college subjects of greatest interest and why?: |
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| Honors and Awards on Campus and with the Community |
| In order of importance to you, please list all honors, awards and/or areas in which you have distinguished yourself. Also list your aspirations for your remaining time in college (list current first): |
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| Fraternity Experiences |
| In order of importance to you, please list all offices or positions held. Also list your aspirations for the future before graduation. (list year in school office was held): |
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| Other Activities |
| Please list all other college or civic activities and organizations to which you belong(ed) and offices held: |
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| Employment Background |
| Company/Position/Dates: |
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| Company/Position/Dates: |
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| Company/Position/Dates: |
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| Personal Statements |
| In 500 words or less, indicate your career plans? (include plans for graduate work): |
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| In 500 words or less, give a brief appraisal of yourself. Include a discussion of your strengths as well as weaknesses: |
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| What do you consider the most significant contribution you have made to your Fraternity, campus or community?: |
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| Describe an event or experience, which had significant positive impact on your life: |
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| References |
| Send three letters of reference directly to the Delta Tau Delta Educational Foundation. Acceptable references include current or former teachers, coaches, employers, ministers, or Delta Tau Delta alumni. |
| Please list three references below: |
| Name/Address/Phone/Relationship: |
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| Name/Address/Phone/Relationship: |
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| Name/Address/Phone/Relationship: |
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| Transcripts |
| A transcript of your most recent grade report must be sent to the Delta Tau Delta Educational Foundation. Your application will be considered complete when all three letters of reference, your transcript and your application are received. |
| All applications and supporting material for the File Scholarship for Undergraduate Excellence should be submitted by December 1 to: |
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Delta Tau Delta Educational Foundation
10000 Allisonville Road
Fishers, Indiana 46038
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