2014 Bernard and Ann Svihel Memorial Scholarship

for Electrical Engineering Majors

This scholarship is for electrical engineering students who are currently enrolled or have been
accepted for enrollment in the upcoming semester, who have a history of academic achievement
and who have a need for financial assistance. Return the completed application to the Advising
Office by December 13, 2013.

Application
Name: ___________________________________ MyMav ID #: ________________________
Address: _____________________________________________________________________
City: ___________________________________________ State: ______ ZIP: ____________
Phone: __________________________

E-mail: ____________________________________

Hours completed at UTA: _______________

GPA: ______

Financial Need - The completion of this section is required. Financial need is of prime
importance in the determination of this scholarship.
Martial Status: Single ______

Married ______

Employment Income (previous 12 months)

Employer

Number of dependents ______

Average hours
worked per week

Wage
($/hr)

Family support (spouse, parents, and other relatives - previous 12 months): _________________
______________________________________________________________________________
______________________________________________________________________________

You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you.
You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found
in sections 552.021, 552.023 and 559.004 of the Texas Government Code.

Rev. 1/12/2009

University-supported financial aid (previous 12 months): _______________________________

______________________________________________________________________________
Other income including educational loans and scholarships (previous 12 months): ____________
______________________________________________________________________________
______________________________________________________________________________
Other pertinent financial information such as outstanding debts: __________________________
______________________________________________________________________________
Goals - Please describe your academic and professional goals and how this scholarship will help
you to accomplish those goals.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Extracurricular Activities - List membership and involvement in student organizations, honor
societies, intercollegiate sports and other professional or community organizations.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Academic Honors List any honor or scholarships received.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you.
You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found
in sections 552.021, 552.023 and 559.004 of the Texas Government Code.

Rev. 1/12/2009

State law requires that each student identify any relation to a current member of The University
of Texas System Board of Regents. A student who is related to a current member of the U.T.
System Board of Regents is prohibited from receiving scholarships unless the scholarship is
awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B
misdemeanor to file a false statement.
Are you related to any member of the U.T. System Board of Regents? _____________________
If yes, please identify the Board member and the relationship: ____________________________
______________________________________________________________________________
Applicable relationships include one of the following
1. Regentsspouse, spouses child, spouses parent, childs spouse, parents spouse.
2. Regentsspouses brother or sister, spouses grandparent, spouses grandchild,
brothers or sisters spouse, grandparents spouse, grandchilds spouse.
3. Regentsparent, daughter, son.
4. Regentsbrother, sister, grandparent, grandchild.
5. Regentsgreat-grandparent, great-grandchild, uncle or aunt (brother or sister of
parent) nephew or niece (son or daughter of brother or sister).
A list of the current members of The University of Texas System Board of Regents is available
at http://www.utsystem.edu/bor/currentRegents.htm.

You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you.
You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found
in sections 552.021, 552.023 and 559.004 of the Texas Government Code.

Rev. 1/12/2009