Endowed Scholarship Questionnaire

Registration Information
First Name:
Middle Name:
Last Name:
Drury ID:
Forms submitted without a valid Drury ID number will not be processed.
Zip Code:
Missouri Residents Only
Gender Male   Female
High School:
High School Class Rank*:
*(If your school does not rank, please answer "0")
High School Class Size*:
*(If your school does not rank, please answer "0")
Class During 2014-2015 Academic Year:
Marital Status:
Religious Affiliation:
Church Attending:
Are you in the Missouri A+ Program? Yes   No
Are you pursuing an IB Diploma? Yes   No
Are you a National Merit Semifinalist? Yes   No
Did you attend Boys State or Girls State? Yes   No
Are you a Drury Student-Athlete?
Is your parent or grandparent a Drury alumni? Yes   No
If yes, please enter their name, graduation year, and relation:
Is your parent an ordained minister in the Disciples of Christ or United Church of Christ?
Yes   No
Are you a member of a sorority or fraternity?
Number of community service hours performed last year?
Are you an Eagle Scout? (Men only) Yes   No
Are you a Girl Scout Gold Award recipient? (Women only) Yes   No
Are you a descendant of:
(Choose any that apply)
Ormal Creach  Dale & David Creach  Monta Creach  Horace Haseltine  
Steve and Patsy Palmer  Milton or Sue Phillips  A. Ronald & Maxine Stewart  
John Sturgis  
Are you a descendant of a US Marine or Navy Veteran who is also an alumnus or trustee of Drury University?
Yes  No
If yes, name and branch of service:
Is your parent or grandparent a Burlington Northern Railroad employee/retiree? Yes  No
If yes, name and relationship to you:
I have provided accurate and honest information, and I understand that misrepresentation of my credentials could result in the reduction or elimination of endowed scholarship funding. If I am asked to provide proof of any credential above, I agree to do so. Acceptance of any scholarship constitutes an agreement to write an acknowledgement letter to the donor.
Please Enter Text Shown Above: