Dwyer Williams Potter Attorneys, LLP Law School Scholarship Application Form STUDENT INFORMATION Name (Last, First, MI):___________________________________________________________________ Are you a U.S. citizen or otherwise authorized to work in the United States? ___Yes ___No Name and city of law school you are planning to attend: _______________________________________ _________________________________________________________________________________ ____ Present mailing address (Street, Apt. # City, State, Zip code):____________________________________ _________________________________________________________________________________ ____ Telephone #: __________________________________ E-Mail: _______________________________________ ACADEMIC INFORMATION Schools Address Dates Degree / Major Date of Graduation Current Major(s): ______________________________________________________________________ Highlight honors or awards that you have received: Is there any other relevant information you want us to consider when reviewing your application? Please tell us how you learned about our scholarship program: ESSAY INSTRUCTIONS: Please submit a one to three (1-3) page essay describing why you believe you are the most deserving recipient for this law school scholarship. Please attach your essay as a separate document. CERTIFICATION: I hereby certify that the information I have provided on this Application Form and in any attached materials is true and complete. Applicant Signature: _________________________________________________________________ Date: __________________, 20___ Return completed application and requisite materials either by mail or by e-mail in PDF format by July 1, 2016 to: Dwyer Williams Potter Attorneys, LLP Attn: Tim Williams 1051 NW Bond St. Suite 310 Bend, OR 97701 [email protected] For more information, visit www.roydwyer.com Note: This application and supporting material must be received by July 1st, 2016. Notification of the scholarship award decision will be made on or around August 1st, 2016.
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