• Visit the Office of the Registrar (Lucina Hall, B43) and show them your BSU ID
• Issue transcript to: H&A Selection Committee c/o Kim Stassen
• Make sure the transcript is in a sealed and signed envelope.
• Drop off or mail the transcript to:
H&A Selection Committee c/o Kim Stassen
Department of Nutrition and Health Science
Cooper Science Building, CL325
Ball State University
Muncie, IN 47306
Online:
If you wish to request a transcript online and have it sent directly to the H&A Selection Com-mittee, please
follow the directions below:
• Request an official printed transcript (sealed and signed envelope) through Self-Service Ban-ner.
Instructions at: http://cms.bsu.edu/about/administrativeoffices/registrar/transcripts/
• When competing the transcript request, note the following:
o Issue transcript to: H&A Selection Committee c/o Kim Stassen
o Address: Cooper Science Building, CL325 Muncie, IN 47306
o Only one copy is needed
o There is an option like: print transcript; in the dropdown box choose process now
o Must choose a delivery method: choose postal service
This means you will not need to scan and include your BSU transcript in the application packet.
(The BSU transcript will be added by the committee.)
• If you choose to have your BSU official transcript be delivered electronically, request copies of your
transcript via the National Student Clearinghouse secure order site. Issue transcript to: H&A Selection
Committee c/o Kim Stassen ([email protected]).
Did you attend another college/university?
• Request an official printed transcript (sealed and signed by Registrar) through the institution
and have it mailed to:
H&A Selection Committee c/o Kim Stassen
Department of Nutrition and Health Science
Cooper Science Building, CL325
Ball State University
Muncie, IN 47306
• Official transcripts electronically submitted can be issued to: H&A Selection
Committee c/o Kim Stassen (kstassen@bsu.edu).
How to Request Transcripts
There are several ways to ensure that the Honors and Awards (H&A) Selection Committee has your official
transcript (in a sealed envelope with the Register’s signature across the seal):
In-Person:
All materials must be received by:
12:00 Noon (EST) on February 15, 2019
Incomplete or late applications will not be considered, see instructions on page 4 of application.
I. Scholarships/Awards
(Please check all Scholarships/Awards for which you wish to be considered. Only the scholarships that require an
application are listed. The committee cannot consider a student for a scholarship unless the student has applied for that
scholarship.)
Scholarships for Health Education and Promotion Students:
McKenzie-Walkup Intern Scholarship (seniors only; Internship must be completed by Summer 2019)
McKenzie-Walkup Book Scholarship (junior status)
Ann B. & David A. Westerlund Scholarship in Honor of James F. McKenzie
for Non-Traditional Students
Awarded to eligible undergraduates 25 years of age or older.
Birthdate
Robert H. and Esther L. Cooper Science Scholarship
Sherri Hittson Memorial Scholarship
The Zeberl Family Scholarship
William Bock Health Education Scholarship
Charles R. Carroll Health Education Scholarship
Warren E. Schaller Scholarship
Herb Jones Education Scholarship (sophomore or junior status)
Scholarship Application
Scholarships for Dietetics students:
Mildred Moore Scholarship
Helen J. Snyder Memorial Scholarship
Warner Family & Consumer Science Scholarships
To be awarded Fall 2019:
December
31
(YYYY)
Permanent Address
Apt.Street Address
City State Zip Code
Permanent Phone
III. Academic Information
Current Major(s) GPA
GPACurrent Minor(s)
Overall GPAYear in School Anticipated date of BSU Graduation
GPA
GPA
Minor(s)
Major(s)
Completed Degree(s)
College/University
Graduation Date Overall GPA
List any academic honors or awards you have received
II. Personal Information
Name
Last First MI
Current Address
Apt.Street Address
City State Zip Code
E-mail
Current Phone
IV. Professional Activities and Involvement
List health science or physiology related extra-curricular activities in which you have participated (volunteer experiences, work in
schools, agencies, honorary societies, etc.).
Name of Organization Position or Office Date
List and describe employment, internship, or practicum experience you have had in the health science or physiology area.
to
Describe your basic responsibilities and tasks
Employer/Agency Dates of Employment
to
Describe your basic responsibilities and tasks
Employer/Agency Dates of Employment
V. Statement of Professional Contribution
Describe any contributions you have made to promote school, community, public, or environmental health or physiology.
Describe any contributions you have made to the profession, such as, in school/community/public health, or nutrition for example.
List any health science or nutrition related extra-curricular activities in which you have participated (volunteer experiences, work in
schools, agencies, honorary societies, etc.).
List and describe employment, internship, or practicum experience you have had in the health science or nutrition area.
VI. Additional Information
If applying for the Robert H. and Esther L. Cooper Science Scholarship, please make a statement concerning your use of tobacco,
alcohol, and illegal drugs.
List two professional references below, at least one a department faculty member.
Name Title Business/Organization Phone E-mail
VII. Applicant Statements
Please read the following statement carefully.
If I am selected to receive a scholarship/award*, I understand and give permission for the following: Release of my information
and photograph along with information about the respective scholarship/award by the Department of Physiology and Health
Science and/or Ball State University Marketing and Communications to my hometown newspaper and the department’s Web
site, display board, and alumni newsletter.
DateApplicant's Signature
Attach the following documents:
1. CURRENT RESUMÉ
2 CURRENT DAPR and/or TRANSCRIPT
For the Siverly and Henzlik awards
1. Research Proposal
For Schaller award
1. Two letters of support
Submit your completed application and attached documents to:
ATTN:Honors & Awards Selection Committee
Department of Physiology and Health Science
Cooper Science Building, CL 325
12:00 Noon
Monday, January 22
*Upon receipt of award/scholarship, student will receive a photo release form and a hometown newspaper informational form to be completed and returned to the
Department of Physiology and Health Science.
Application Instructions
1) Completed application packets must be scanned in their entirety and submitted in one PDF. The PDF is to be e-mailed
The application packet materials should be scanned in the following
order:
a) Scholarship application form
b) Current resume
c) Current Degree Works
d) Electronic display questionnaire includes electronic submis
sion of a headshot to be used during the H&A ceremony
(details on the form).
2) Request all transcripts for all academic work after high school.
Refer to the “How to Request Transcripts” page.
Label the PDF using the following format: “[Last name], [First name]
2019 application”
For the Ann B. & David A. Westerlund Scholarship in Honor of
James F. McKenzie for Non-Traditional Students:
a) Student must have filed a FAFSA with the Scholarship and
Financial Aid office in order for eligibility to be determined, as
the award is based upon financial need.
If I am selected to recieve a scholarship/award, I understand and give permission for the following: Release of my informa-
tion and photograph about the respective scholarship/award by the Department of Nutrition and Health Science and/or Ball
State University Division of Strategic Communications to my hometown newspaper and the department’s website, display
board, and alumni newsletter.
Application Check List
c Resume
c Degree Works
c Current Official Transcript
c Electronic Questionnaire
c Applicant Photo Headshot
3)
Typed Name Serves as Signature
1. Preferred Display Name __________________________________________
2. Major ___________________________________________________________
3. Minor ___________________________________________________________
4. Extracurriculars/ Volunteer Work Or Health/ Nutrition Related Experiences
5. Future Plans
6. Please email a clear photo no smaller than 2” x 3” to picture. [email protected].
Name file [Last name], [First name] 2019.
For Office Use Only: Scholarship(s) Awarded
______________________________________________________________________________
______________________________________________________________________________
Electronic Display Questionnaire
