Application For The

PAUL B. PATTERSON SCHOLARSHIP

RETURN TO: The Scholarship Committee 
           Department of Computer Science 
	   P.O. Box 32133
           Appalachian State University 
           Boone, NC 28608 

Also have high school transcript sent to the above address. 
BY:        March 24 
 
Date of Application _____________ Social Sec. Number ___________________
 
Full Name: _____________________________________________________________
 
Address: _______________________________________________________________
 
Phone Number: ____________________ Date of Birth: ______________________
 
 
High School: ___________________________________________________________
 
Address: _______________________________________________________________
 
Date of expected graduation: ____________________ 
 
 
Home town newspaper: ___________________________________________________
 
Address: _______________________________________________________________
 
Parents or guardians: __________________________________________________ 
 
 
Address: _______________________________________________________________
 
Phone Number:___________________________________________________________ 
 
 
Give the name and address of the high school mathematics teacher you 
plan to have submit a letter of recommendation. 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
 
Give the name and address of two other individuals who can be written 
for recommendations.
 
________________________________________________________________________
 
________________________________________________________________________
 
 
Date you plan to enroll at ASU: ________________________________________ 
 
Have you received notice of acceptance to ASU? Yes_____ No_____ 
List your high school extra curricular activities and honors. 
 
 
 
 
 
 
 
 
 
 
 
 
 
Make a statement regarding your career plans in mathematics or
computer science. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signature: ___________________________________ Date: ___________________