*Name:

*Parent/Guardian Name:

*Address:

*City, State, Zip:   *Birth Date:

*E-mail Address:    *Phone:

Scholastic Information:

*GPA (indicate if weighted):      SAT Math:

SAT English: ACT:

*High School:           Class Rank: of

Intended Major:            *Year of Graduation:

*Collegiate Extracurricular Interests:

*Leadership, Activities, & Achievement Information:

Please attach to either the end of this document or another file a copy of your resume. It should include:

• Any honors, awards, or scholarships.
• All extracurricular activities (athletics, clubs, etc.) and positions held.
• Any community involvement, service, or philanthropy.
• Any work experience.

*Short Essay: 

A balanced man is someone who displays the qualities of a leader, a scholar, an athlete, and a gentleman. Please write a one page essay (double spaced) discussing how you embody two of these qualities. This is your opportunity to expand on something interesting on your resume or to demonstrate why you are qualified for this scholarship.

Application Deadline: Monday - October 12th, 2009

Should you have any questions, do not hesitate to e-mail Buck Bennett and Tony Chen, the Balanced Man Scholarship Chairmen, at dukesigep@gmail.com. Please try to keep your resume and essay to one page each and if possible send it all in one document, with the first page being this application, followed by your resume, then your essay. 

*Signature of Applicant (type initials if electronically submitted):     

*Date:

*Denotes Required Field