Phyllis E. Ainsworth Scholarship Application Form
Date: _________________________
Name: __________________________________________________________________
Permanent Address: _______________________________________________________
________________________________________________________________________
________________________________________________________________________
Telephone (home): ______________________ (work): _____________________________
E-mail: __________________________________________________________________
Schools Attended: _________________________________________________________
Section II: Program Information
School to be attended:_____________________________________________________
Degree (MLS, MLIS, MIS, Ph.D., etc): __________________________________________
Address: ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Telephone (voice): _________________________ (fax): ___________________________
Web URL: _______________________________________________________________
Starting date and duration of program: __________________________________________
Other financial aid awards: ___________________________________________________