Presidential Scholar Awardee Information Form

Today's Date *

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Name * First name

Last Name * Last name

Department *

Student's Western Identification Number (WIN) *

E-Mail Address *

Mailing Address (please include street, city, state, zip) *

Anticipated graduation date *

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List your major of study at WMU (noting any concentration, option, etc.) *

Are you are a recipient of a full (4-year) Medallion Scholarship? *

Yes

No

Are you a member of the Lee Honors College? *

Yes

No

Where do you consider your hometown, along with city/state?

Name and city of the high school you graduated from

List other higher education institution(s), along with city/state, you graduated from and degree(s) earned

Confirm your attendance at the in-person event *

Yes

No

Name of Guest-1

Name of Guest-2

Name of Faculty Guest

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