Application Checklist

Verne LaMarr Lyons Memorial MSW Scholarship

Please sign and return with your completed application.

Name

Last ___________________ First ___________________

Middle _________________

Address

Street Address ___________________________________________________________

City _____________________ State ___________________ Zip ___________________

I have included, in the following order, the original documents with four copies

r Copy of NASW membership card

r Application Form

r Biographical Essay

r Two letters of support

r Official Transcript

r Letter of acceptance to MSW program or a copy of the application to an accredited MSW program (if the applicant is not currently enrolled in an accredited MSW program)

r A letter form the candidates academic advisor-for candidates applying for continued funding through the Lyons Scholarship fund only

r Signed release of information

r Application checklist

Please sign this form below, attesting to the accuracy of the information you have provided.

Signature of Applicant ________________________________________ Date ______________

Please mail to:

NASW Foundation
Executive Office
750 First Street, NE, Suite 700
Washington, DC 20002-4241

Questions? Call the hotline at 800-638-8799, Ext. 504

E-mail us at naswfoundation@naswdc.org