AUSTIN CPA CHAPTER/CPE FOUNDATION Becker Review Course Scholarship GUIDELINES AND INSTRUCTIONS

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1 AUSTIN CPA CHAPTER/CPE FOUNDATION Becker Review Course Scholarship GUIDELINES AND INSTRUCTIONS The Becker Review Course Scholarship offered by the Austin CPA Chapter/CPE Foundation covers 2 sections of the Becker Review Course. To be considered for this Scholarship, a student/candidate must: Be a current TSCPA Student/Candidate member ($35). Student or graduate of an accounting program with the intent of becoming a Certified Public Accountant and entering the accounting profession who is a: o Senior accounting major or graduate student in accounting attending a university in the Austin Chapter Area where classes are approved by the Texas State Board of Public Accountancy, o OR a student of Austin Community College s Professional Accountant, Advanced Technical Certificate program o OR an accounting graduate (Candidate member). Submit the following to the Austin CPA Chapter/CPE Foundation Scholarship Committee, Austin CPA Chapter, 3305 Northland Drive, #406, Austin, TX, 78731, and MUST be received by April 30, 2014: o A typed letter addressed to the Scholarship Committee, Austin CPA Chapter/CPE Foundation, explaining why the Becker Review Course Scholarship would make a difference in your pursuit to become a CPA o A copy of the acknowledgement letter from the Texas State Board of Public Accountancy indicating you have submitted an Application of Intent to The Board for the purpose of taking the CPA exam and becoming a CPA in the state of Texas. o Cumulative college transcript(s) (unofficial transcripts acceptable) to include credit hours earned from all colleges and universities and cumulative GPA. Two (2) Becker Review Course Scholarships good for attendance at classes covering 2 sections (your choice which two) of the CPA Exam. Incomplete or late applications will not be considered. THIS APPLICATION WILL BE FOR USE BY THE AUSTIN CPA CHAPTER ONLY, AND IS NOT TO BE TRANSFERRED TO ANY THIRD PARTIES, IN COMPLIANCE WITH TEXAS OPEN RECORDS LAW AND FEDERAL EDUCATION RIGHTS AND PRIVACY ACT OF Application is also available online at

2 AUSTIN CPA CHAPTER/CPE FOUNDATION Becker Review Course Scholarship APPLICATION (Please type or print in black ink.) 1. NAME: LAST FIRST MIDDLE OR MAIDEN 2. CURRENT ADDRESS: STREET ADDRESS OR P.O. BOX APARTMENT NUMBER CITY STATE ZIP CODE TELEPHONE NUMBER ADDRESS 3. PERMANENT ADDRESS (IF DIFFERENT) STREET ADDRESS OR P.O. BOX APARTMENT NUMBER CITY STATE ZIP CODE TELEPHONE NUMBER ADDRESS 4. DATE OF BIRTH: How did you hear about this Scholarship? MONTH/DAY/YEAR EDUCATIONAL INFORMATION 5. UNIVERSITY/SCHOOL 6. CLASSIFICATION AS OF END OF FALL 2012 SEMESTER: SENIOR GRADUATE STUDENT GRADUATE If current student, please complete #7 - #10: 7. TOTAL CREDIT HOURS EARNED THROUGH FALL SEMESTER 2012: CUMULATIVE G.P.A. ACCOUNTING G.P.A. 8. TOTAL CREDIT HOURS (INCLUDING ALL SUBJECTS) FOR WHICH YOU ARE OR WILL BE ENROLLED DURING THE FOLLOWING SEMESTERS: SPRING 2013: SUMMER SCHOOL 2013: 9. DEGREE(S) SOUGHT: EXPECTED GRADUATION DATE:

3 PAGE 2 STUDENT/CANDIDATE NAME: EDUCATIONAL INFORMATION (CONT.) 10. LIST ADDITIONAL ACCOUNTING AND BUSINESS COURSES PLANNED FOR THE SPRING SEMESTER COURSE NAME (DO NOT LIST CATALOG NUMBERS) CREDIT HOURS NUMBER OF ACCREDITED ACCOUNTING HOURS BY DEGREE TIME: For graduates: DEGREE(S) EARNED: DATE: ATTACH TRANSCRIPTS (Unofficial transcripts accepted) FROM ALL COLLEGES AND UNIVERSITIES ATTENDED. 11. Does your firm provide a Review Course? YES NO 12. Does your firm pay for a Review Course? YES NO 13. Have you taken any parts of a Review Course? YES NO If yes, which ones? 14. Have you taken or passed any part of the CPA Exam? YES NO If yes, which ones?

4 PAGE 3 STUDENT/CANDIDATE NAME: 14. LIST PRINCIPAL EXTRACURRICULAR ACTIVITIES, ORGANIZATIONS (INDICATE WHETHER SOCIAL, ACADEMIC OR SERVICE), COLLEGE HONORS, LEADERSHIP POSITIONS. ATTACH RESUME OR ADDITIONAL SHEET IF NECESSARY. _ EMPLOYMENT HISTORY 15. GIVE EMPLOYMENT HISTORY (LIST NAME OF COMPANY, SUPERVISOR'S NAME, COMPANY ADDRESS, AND DATES EMPLOYED. LIST FULL-TIME AND PART-TIME JOBS, INCLUDING INTERNSHIPS. LIST MOST RECENT JOB FIRST. ATTACH SECOND SHEET IF NECESSARY) COMPANY ADDRESS: TELEPHONE: NATURE OF WORK: EMPLOYED FROM: TO COMPANY ADDRESS: TELEPHONE: NATURE OF WORK: EMPLOYED FROM: TO COMPANY ADDRESS: TELEPHONE: NATURE OF WORK: EMPLOYED FROM: TO

5 PAGE 4 STUDENT/CANDIDATE NAME: BY MY SIGNATURE ON THIS APPLICATION AND ACCOMPANYING LETTER, I HEREBY STATE THAT I MEET ALL OF THE REQUIREMENTS FOR SCHOLARSHIP RECIPIENTS LISTED ON PAGE ONE OF THIS APPLICATION, AND THAT ALL INFORMATION GIVEN IS CORRECT AND COMPLETE. I GIVE THE AUSTIN CPA CHAPTER/TSCPA AUTHORITY TO CONTACT ANY INSTITUTION, COMPANY OR INDIVIDUAL I HAVE NAMED TO CONFIRM THAT THE FACTS STATED ARE ACCURATE, OR FOR PURPOSES OF GENERAL REFERENCE. IF I AM SELECTED AS A RECIPIENT OF AN AUSTIN CPA CHAPTER/CPE FOUNDATION SCHOLARSHIP, I HEREBY GRANT PERMISSION TO THE AUSTIN CPA CHAPTER/TSCPA TO PUBLICIZE MY SELECTION. SIGNATURE OF APPLICANT DATE I have included my essay I have included my transcripts (unofficial transcripts accepted) I have included my Acknowledgement Letter from the TSBPA Mail to: Diane Joiner, Executive Director Austin CPA Chapter/CPE Foundation Scholarship Committee 3305 Northland Dr. #406 Austin, TX 78731