IABA - Scholarships

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Scholarship Application

Select the minority group you belong to:

Do you intend to explore employment opportunities in the U.S. or Canada?

PERSONAL DATA

Applicant’s Last Name:

Applicant’s Middle Name:

Applicant’s First Name:

Applicant’s Street Address:

Applicant’s City, State, Zip:

Applicant’s Phone Number:

Applicant’s Email Address:

School’s Street Address:

School’s City, State, Zip:

School Phone Number:

Sex:

Date of Birth (MMDDYYYY):

Are you a U.S. or Canadian Citizen?

If U.S., Social Security Number:

If no, type of Visa:

Place of Birth:

Have you participated in a summer actuarial program at:

Howard University?	Yes No
If so, when?
Illinois State U.?	Yes No
If so, when?
Temple U.?	Yes No
If so, when?

EDUCATIONAL RECORD
Show most recent school first; Submit an officially sealed current college transcript sent directly from your school(s).

School (City, State)	Attended		Major Course of Study	Current or Final Grade Average	School's Maximum Grade	Date of Graduation
School (City, State)	From	To	Major Course of Study	Current or Final Grade Average	School's Maximum Grade	Date of Graduation

*GPA Basis (For example: A = 5.0; A = 4.0; E - Excellent; 100; Other) Please explain:

EMPLOYMENT/INTERNSHIP RECORD
(Show most recent employer first)

Employer	Date Employed	Nature of Work	Reason for Leaving

CURRENT EDUCATIONAL PLANS

During the 2008-09 school year, you will be enrolled as a:

The school you expect to attend is:

This school’s grading period is:

During the 2008-09 school year, you will be a:

Does this school have an Actuarial Science program?

If yes, will you be enrolled in the program during the next school year?

If you have declared a major, what is it?

EDUCATIONAL EXAMINATION SCORES
Indicate your scores for any of the following tests you have taken and also forward a copy of an officially sealed record of each test taken:

(Check, if applicable) I have applied for an IABA Actuarial Scholarship within the last 3 years and have already sent in my exam scores. Year(s) applied for scholarship:

Test	Score	Date Taken (Month, Year)
Preliminary Scholarship Aptitude Test (PSAT)
Verbal
Quantitative
Scholastic Aptitude Test (SAT)
Verbal
Quantitative
American College Testing Assessment (ACT)
Verbal
Quantitative
Graduate Record Exam (GRE)
Other (Specify and identify the maximum possible score for such examination, i.e., Advanced Placement Calculus)

ACTUARIAL EXAMINATION RECORD
Please indicate examinations written, scores, and dates taken. Also indicate if you will be writing an examination during the 2008-09 school year. Note: You are expected to take an actuarial exam as soon as you have finished courses relating to material tested, particularly if you have received one of our scholarships. Visit www.BeAnActuary.org for a description of the courses and what the exams cover in the “Actuarial Exams” section.

	Course	Score	Date Taken		Course	Score	Date Taken
1				2
3				4
5				6
7				8

FINANCIAL STATEMENT
Note: This form is to be completed by the applicant, in consultation with his or her parent or guardian. The information must be accurate and will be kept strictly confidential.

In addition to this Financial Statement, your financial data must include a copy of the Student Aid Report (SAR) from the U.S. Department of Education. Otherwise you must provide a written explanation why these documents are not included.

FINANCIAL AID REQUESTED
From what schools and/or agencies have you applied for scholarships or other financial aid?

Type	Amount Applied For	Amount Awarded (if known)	Amount Awarded Last Year
Government Grants



Government Loans

University or College Scholarship
University or College Loans
Other (Please itemize and describe)

IMPORTANT: Include a copy from the college or university’s catalog/information sheet showing fee estimates and other expenses for the academic school year.

All information provided is subject to external verification

PERSONAL STATEMENTS

Why are you interested in becoming an actuary?

Write a brief description of your school activities, organization memberships, community activities, hobbies, special talents, sports, etc., in which you take part or are interested.

Certification: By checking the box below, I certify all of the information on this form is true and complete to the best of my knowledge. I understand that if I have provided any false or misleading information, any scholarship benefits awarded to me may be denied or rescinded and other appropriate action taken.

Check here to acknowledge
the above certification.

Date: