Mission Statement

ALICE L. HALTOM EDUCATIONAL FUND SCHOLARSHIP APPLICATION The Alice L. Haltom Educational Fund operates exclusively for charitable, literary and educational purposes, specifically in connection with the study, research and dissemination of information in records and information management and related fields. The Fund, organized in 1985, is supported by contributions from various chapters of ARMA International, companies, individuals and other organizations. ARMA Houston created the Fund to honor Alice L. Haltom, CRM for her untiring efforts to improve the profession of information and records management during her career that spanned more than three decades.

Scholarship Application

Incomplete or late applications will not be considered for scholarship awards. After submitting the application, please thoroughly read the next page.

Scholarship Eligibility Information

Students who are citizens of the United States or Canada and actively pursuing undergraduate and post- graduate degrees related to careers in information and records management.

Application Deadline

Scholarship applications must be post marked to the Fund by May 1 the year of the funding. Complete the application and mail with required attachments to the address shown on the last page of this form. Notification regarding the award will be sent no later than July 15th.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Citizenship

Choose one.

Canada

United States

How did you learn about the scholarship?

Are you an ARMA member?

If you are a member of another professional organization please list them below.

Objectives

School you will be attending next year.

Will you be attending:

Address of school you plan to attend.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Declared Major

Most recent grade point average.

Type of degree program:

Career Objective

Education

Please list your most recent school first.

School

Dates attended

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional School

School

Dates attended

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional educational information for scholarship consideration.

Work Experience

Most recent experience first.

Employer

(most recent)

Nature of employment

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Brief description of duties

Supervisor's name

First Name

Last Name

Supervisor's phone

(###)

###

####

Dates of employment

Additional Employment

Employer

Nature of Employment

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Brief description of duties

Supervisor's name

First Name

Last Name

Supervisor's phone

(###)

###

####

Dates of Employment

Additional employment in records and information management for scholarship consideration.

Volunteering

Volunteer involvement for scholarship consideration.

Financial Need (For upcoming academic year only.)

Anticipated cost of books for next academic year?

Anticipated cost of fees for next academic year?

Anticipated cost of tuition for next academic year?

Total estimated expenses (excluding housing) for the next academic year?

If your employer provides financial aid please describe.

List all scholarships and grants you have been awarded that will be used for the upcoming academic year

Please list one per line.

Total amount of scholarships and grants for the upcoming academic year.

Total amount of financial assistance (scholarships, grants, and employer support) for next academic year?

Financial need:

The difference between your total assistance (plus any aid) and your estimated expenses.

CERTIFICATION STATEMENT

By submitting this application and attachments, I certify that the information provided is complete and accurate to the best of my knowledge. I understand that falsification may result in the revoking of any scholarship granted. If awarded a scholarship, I will provide my Unites Sates social security number or Canadian social insurance number and realize that if my grades are not provided to the Fund within sixty (60) days after the school term ends, a Form 1099 for the award proceeds will be sent to the Internal Revenue Service for income tax purposes. I also give my permission to use my name in any public announcement associated with my attainment of an Alice L. Haltom Educational Fund Scholarship.

STOP - PRINT THIS PAGE FOR YOUR RECORDS BEFORE SUBMITTING.