Springbrook Scholars Application

Application Deadline Dates are as follows:

Summer Semester: March 15
Fall Semester: July 15
Spring Semester: November 15

Please note, if the above date falls on a weekend, the Springbrook Scholars Application will be due on the preceding Friday.

Name*

First NameLast Name

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Phone Number*

Area CodePhone Number

Employee Email:*

example@example.com

Date of Hire:*

Date

Department:*

Work Location:*

Current Position:*

Department Director:

First NameLast Name

Director Email Address:

example@example.com

Proposed Educational Institution:*

Proposed Major or Field of Study:*

Anticipated Program Completion Date:*

Date

Is the program Accredited?*

YesNo

Degree Level*

Springbrook Scholars Program:*

Semester/Year*

Fall 2019Spring 2020Summer 2020

Course Title:

Course Title (if applicable)

Course Level

UndergradauteGraduate

Other Source of Payment:

Amount of Other Source(s) of Payment: $

Net Cost of Course(s): $

Please attach an itemized statement of tuition and fees to this application. Please also note that an official transcript, grade report, or certification of completion, must be submitted to the Talent Acquisition University Relations Coordinator within 60 days of completing the approved courses(s).

Itemized Statement of Tuition & Fees:

Browse Files

Personal Statement of Intent:

Browse Files

Employee Signature:

Springbrook Scholars Application

Section 1: Personal & Employment Information

Section 2: College/University & Springbrook Scholars Information:

Section 3: Tuition Reimbursement Information

Personal Statement of Intent