Women of Impact Scholarship

Application Form
The women of Alpha Chi Omega are devoted to honoring undergraduate women who are
making an impact on women’s lives within the community. The scholarship and accompanying
award night’s purpose is to empower women and encourage the fight against domestic violence
— our national organization’s philanthropy.

Selection Criteria:
• Must be female
• Must be a full-time undergraduate student at the University of Southern California
• Must demonstrate leadership roles on campus or in the community
• Must have a GPA of at least 2.6

Application Instructions:
• Please e-mail your finished application alphachiwoi@gmail.com by March 23, 2009.
Women of Impact Scholarship Application

1. PERSONAL INFORMATION
Name:________________________________________________________________________
USCID#:______________________________________________________________________
Campus address:________________________________________________________________
City:____________________________ State:______________________ Zip:_______________
Permanent address:______________________________________________________________
City:_____________________________State:______________________Zip:_______________
Telephone number:__________________________ Mobile number:______________________
Email address:__________________________________________________________________
Student status (circle one): freshman sophomore junior senior
Major(s):______________________________________________________________________
Minor(s):____________________________________
GPA:_______________

2. INDIVIDUAL STATEMENTS

Please list your involvement on campus and in the community, and include all leadership roles
you have held since enrolling at USC:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____
_____________________________________________________________________________
_

In one paragraph or less, please describe how a female role model or mentor has inspired you:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_______

How has your work in the community helped promote the role of women in society, and how do
you plan to continue that work in the future?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_______
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____