CHARLES W. CUMMINGS SCHOLARSHIP APPLICATION

Degree:

Institution:

Year:

Major:

Grade Point Average:
Undergraduate

Graduate

Special education position
and related experience
(Limit information to this
space only)

Related professional activities
and service (Limit information
to this space only)

How will this scholarship be
used to assist you in attaining
a post-graduate degree in
special education administration
or in attaining special education
administration certification?

In the space below, provide a
narrative describing your future
professional goals and aspirations.

Name:

Address:

City:

State:

Zip Code:

Email:

Phone:

Nominated by:

CEC division membership: