Chancellor Scholarship Application

Student Information
Log in to PASS EXPRESS ( Once logged in, click on your name in the upper left corner and your EmplID should be listed there. If you have any questions, please contact the helpdesk at 608-342-1400 or email them at
High School
Activity and Experience
List all Extra-Curricular School and Community Activities
Extra-Curricular School and Community Activity 1
Extra-Curricular School and Community Activity 2
Extra-Curricular School and Community Activity 3
Extra-Curricular School and Community Activity 4
Extra-Curricular School and Community Activity 5
Extra-Curricular School and Community Activity 6
List all Academic Honors
Academic Honor 1
Academic Honor 2
Academic Honor 3
Academic Honor 4
Academic Honor 5
Academic Honor 6
List all Work Experiences
Work Experience 1
Work Experience 2
Work Experience 3
Work Experience 4
Work Experience 5
Work Experience 6
Personal Statement and Certification

Personal Statement
Please provide your typed, double-spaced statement addressing the following items. (Be sure to include your name and birthdate at the top of each attachment.)

  1. Describe your short-term and long-term aspirations and goals in terms of your education and career. Discuss how your qualities of character, significant life experiences, leadership, and resilience will help you reach those goals.
  2. Highlight personal academic and leadership accomplishments, achievements and experiences that have evoked pride and satisfaction in your life.

Disclaimer: The information listed on this application is true and accurate to the best of my knowledge. I understand that this information and any supporting documents will be held in strict confidential by UW-Platteville Scholarship Committees and the UW-Platteville Financial Aid Office. Since academic performance and financial need are factors considered in the selection of the recipients for many of these awards, I hereby give permission to the appropriate UW-Platteville Scholarship Committees to have necessary information available in the Offices of the Registrar and Admissions and Enrollment.

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