SCHOLARSHIP APPLICATION FORM

1 WSPE SCHOLARSHIP APPLICATION form WISCONSIN SOCIETY OF PROFESSIONAL ENGINEERS 2017- 2018 PERSONAL INFORMATION (please print) Name: Special Consideration yes no (last) (first) ( ) Permanent Address: (Number & street) (City) (State) (zip) E-mail of student: E-mail of parent: Phone No. WI County of High School (area code) Name of High School: Field of engineering that interests you: Are you a citizen of the Yes No A resident of Wisconsin?

1 WSPE SCHOLARSHIP APPLICATION FORM WISCONSIN SOCIETY OF PROFESSIONAL ENGINEERS 2017-2018 PERSONAL INFORMATION (please print) Name: Special Consideration yes no

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