Some of the endowed and gift scholarships that support the funding of Knox Grant/Scholarships have special eligibility requirements.  Your answers to the questions below will help us make the best use of these funds.  Please provide as much detail as possible.  Submission of this form authorizes the Office of Financial Aid and/or the Office of Advancement permission to release the information reported on this form to sponsor(s) of my Knox Grant/Scholarship.

Q1	Full Name:

Q2	Age:

Permanent Address Information:

Q3	State:

Q4	County (in the State given above):

Q5	High School you graduated from:

Q6	Major or Area of Interest:

Q7	Career Goal(s):

Q8	Athletic Activities:

Q9	Musical Activities

Q10	Current Fraternity/Sorority:

Q11	Club/Organization Membership & Offices held (most recent first):

Q12	Volunteer Activities (most recent first):

Q13	Other Extra-Curricular Activities:

Q14	Are either of your parents employed by the Burlington Northern Santa Fe Railroad?
		Yes
		No

Q15	Are either of your parents deceased?
		Yes
		No

Q16	Are you a first-generation college student?  (Neither parent attended college.)
		Yes
		No

Q17	Are you the descendant of a person who served in the U.S. armed forces during World War I or II?
		No
		Yes - WWI
		Yes - WWII

	Name of Relative if applicable - WWI
	Name of Relative if applicable - WWII

Q18	Are you a Navajo Indian or a descendant of a Navajo Indian?
		Yes
		No

Q19	Are you preparing for a career in business?
		Yes
		No

Q20	Do you plan to go to graduate/professional school?
		Yes
		No

Q21	For music majors only?
		Yes		No
	Do you smoke cigarettes?
	Do you drink alcoholic beverages?

KNOX COLLEGE SCHOLARSHIP QUESTIONNAIRE AND RELEASE OF INFORMATION AUTHORIZATIONS

Donors of some of the endowed and gift scholarships, which support the funding of Knox Grant/Scholarships, have stipulated that recipients meet specific eligibility requirements.  Recipients of Knox Grant/Scholarship funds are asked to complete this Scholarship Questionnaire  and agree to the Release of Information Authorizations by submitting this form.  The information you provide allows the Office of Financial Aid to match students with these endowed and gift scholarships.   If you are named to one of these funds, it is likely that you will be required to write a thank you letter to the donor.  Your cooperation in completing this questionnaire and responding to a request to write a letter is appreciated.

OFFICE OF FINANCIAL AID / OFFICE OF ADVANCEMENT RELEASE OF INFORMATION AUTHORIZATION

I request that the Registrar’s Office release my current cumulative grade point average to the Office of Financial Aid and/or the Office of Advancement for the purpose of transmitting the information to sponsor(s) of my Knox Grant/Scholarship.

Submit this form if you agree to release the information as listed above.