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You are here: Central Texas Chapter > Scholarships > Scholarship Form

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Scholarship Form


The Central Texas Chapter of the CPCU Society offers scholarships to local college and university students who are majoring or minoring (a "concentration") in insurance, risk management or actuarial science.

The form below may be completed "online" and then mail to State Farm Insurance, Attn: Cheryl Ramsey; 8900 Amberglen Blvd; Austin, TX 78729. Please PRINT a copy for yourself as well so that you have a copy for your records.

Application Date: (mm/dd/yyyy) Local telephone number:
Name of employer/educational institution: Email address:
Full Name: Date of Birth: (mm/dd/yyyy)
Local Address: City, State, ZIP:
Step One - do you qualify? (only one "yes" is indicated, as your answer must be "yes" to ALL of these questions).
  1. Are your presently a candidate for a bachelor's or higher degree with a major or minor (a "concentration") in insurance, risk management, or actuarial science?
  2. Are you currently attending a college or university and will be completing or have completed your second year
  3. Have you successfully completed a course in insurance, actuarial science, or risk management, or industry certificate-oriented or designation-oriented course such as CPCU 510?
  4. Do you currently have a grade point of at least 3.0 (on an overall 4.0 scale)?
  5. Are you presently NOT receiving full reimbursement for the expense of tuition, books, testing fees, from your employer or any other outside source?

Step Two - answer each of the questions below, then proceed to step three:

Are you qualified for Financial Aid from a college or University ?

Are you categorized as dependent or independent financially?

Education:

Major:
Classification: (Fresh/Grad. et al)
Expected Date of Graduation: (mm/dd/yy)
GRE Score:
GMAT Score:
Grade point Average (A = 4.0)
Overall:
Risk Management & Insurance Course(s) (incl. CPCU):
Last 60 Hours: 
No. of Hours Completed at college or university:
No. of Hours in Business, Actuarial Sciences courses:
Other colleges and Universities attended - enter the following details below:
Institution: 
Major:
Dates: 
Degree:
GPA:
Institution: 
Major:
Dates: 
Degree:
GPA:
Institution: 
Major:
Dates: 
Degree:
GPA:
Risk Management and Insurance Courses taken or currently enrolled in (include American Institutes courses such as INS, ARM, AIC):
Course:  Grade:
Course:  Grade:
Course:  Grade:
Course:  Grade:
Course:  Grade:
Course:  Grade:
Course:  Grade:
Course:  Grade:
Academic and other honors received and/or professional exams passed:
Name & date:
Name & date:
Name & date:
Financial Support:
Average number of hours worked per week while attending college or university: 
Percentage of college or university Expenses Self-Earned: 
Currently:    
(Do not include parental support in percentage)

Scholarships or other Financial Aids that you are currently receiving or will receive in the coming academic year:

Donor:Amount:
Donor:Amount:
Donor:Amount:

Extracurricular Activities (list most important first)
Organization:
Responsibilities:
Dates:
Organization:
Responsibilities:
Dates:
Organization:
Responsibilities:
Dates:
Work Experience:
Company:
Position:
Dates:
Company:
Position:
Dates:
Company:
Position:
Dates:
Step Three - Type below all additional information you would like to provide. This is an important area where you can express your interest. In particular, please discuss your interests in Risk Management and  Insurance and how Risk Management fits into your ultimate career interests. 

(Remember these scholarships are intended to further student's interest and studies in Risk Management, so be as specific as possible)