Section 1 of 7
WIRSA Student Development Scholarship Application
Section 2 of 7
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Section 3 of 7
Contact Information
Name
Name
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Institution
Institution
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Local Address
Local Address
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Local City, State, Zip
Local City, State, Zip
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Preferred Phone
Preferred Phone
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Email
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Year in School
Year in School
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Major (undergrad)
Major (undergrad)
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Minor
Minor
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Field of Study (Grad)
Field of Study (Grad)
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Anticipated Graduation Date
Anticipated Graduation Date
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Section 4 of 7
Student Development Opportunity
Please select which opportunity you plan to attend.
Please select which opportunity you plan to attend.
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AORE National Conference
NIRSA National Conference
Officials Clinic/Tournament
Region III Student Lead-On
WIRSA State Conference
Other…
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Dates and location of development opportunity (indicate start and end date along with city and state)
Dates and location of development opportunity (indicate start and end date along with city and state)
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Section 5 of 7
Scholarship Agreement
All applicants are responsible for reading the Student Development Scholarship Information (link above). Once read, select the choice below to agree to the terms of the student development scholarship.
All applicants are responsible for reading the Student Development Scholarship Information (link above). Once read, select the choice below to agree to the terms of the student development scholarship.
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Yes I have read and understand the information and I agree to the terms of the scholarship.
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Section 6 of 7
Director/Chair Contact Information
Please provide the following contact information for the Director of Recreational Sports or Department Chair at your institution. This person may be contacted to verify the eligibility requirements listed below have been met:
1. Enrolled as undergraduate or graduate student or completing internship at a Wisconsin institution during the academic term for which funds are received.
2. Employed by the campus recreational sports program at current institution and/or enrolled in a degree program studying recreation or a related field, OR
3. Serve as committee member for campus recreation-related committee.
1. Enrolled as undergraduate or graduate student or completing internship at a Wisconsin institution during the academic term for which funds are received.
2. Employed by the campus recreational sports program at current institution and/or enrolled in a degree program studying recreation or a related field, OR
3. Serve as committee member for campus recreation-related committee.
Director/Chair's Name
Director/Chair's Name
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Title
Title
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Department/Division
Department/Division
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Phone
Phone
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Email
Email
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Section 7 of 7
To Complete Application:
RECOMMENDATION FORM: Please have a supervisor (if work-related application) or instructor (if academic-related application) complete and submit one recommendation on WIRSA Student Development Scholarship Recommendation Form. You are responsible for sending them the link and for ensuring form is RECEIVED no later than 30 days prior to event.
APPLICATION MATERIALS TO SEND: Please visit http://www.mywirsa.com/scholarships.html to review the submission requirements for your application. Your application is not complete and will not be considered until this form is submitted and all required documents are submitted to Mackenzie Stutzman at stutzmanm@uwstout.edu.
Contact Mackenzie Stutzman at stutzmanm@uwstout.edu with any questions.
APPLICATION MATERIALS TO SEND: Please visit http://www.mywirsa.com/scholarships.html to review the submission requirements for your application. Your application is not complete and will not be considered until this form is submitted and all required documents are submitted to Mackenzie Stutzman at stutzmanm@uwstout.edu.
Contact Mackenzie Stutzman at stutzmanm@uwstout.edu with any questions.
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