All full-time, Oklahoma elementary or secondary school teachers and administrators who qualify for admission to the graduate school and wish to enroll on a part-time basis may apply for a one-third tuition scholarship by completing the following information and returning it to the University of Tulsa Graduate School on or before the time of enrollment.

Name (Last)_________________First___________________Middle_____________S.S.No.______________

Address__________________________________City_____________St_____Zip________________

Place of Employment________________________________________________________________________

Address__________________________________City_____________St_____Zip________________

Position Held/Classes Taught____________________________________________________________________________


__________________________________________________________________________________


Purpose for Pursuing Graduate School_______________________________________________________________________________


____________________________________________________________________________________

Graduate Major___________________________________________________________________

I understand that a graduate tuition scholarship may be terminated at any time for (1) failure to maintain a satisfactory academic record, or (2) failure to abide by the rules and regulations of the University, now existing or existing in the future.

Signature of Applicant____________________________________________________Date______________


Signature of Employer_________________________________________ Date ______________

Titile of Employer________________________________________________________________


Signature of Graduate Dean_____________________________________Date________________