DEPARTMENT OF CHEMISTRY
JOINT SCHOLARSHIP APPLICATION
and
MUST BE SUBMITTED BY MARCH 31
The Bernard J. Katchman Memorial Scholarship is awarded
to an undergraduate Chemistry or Biochemistry major. It is a
renewable 2-year award, covering the first two years of
attendance at UD, consisting of $625 per year. At the end of
their second year, Katchman Scholars will automatically be
awarded the Carl I. Michaelis Scholarship Award in their
third and fourth years in the amount of $5,000 per year. This
will bring the total joint scholarship award to $11,250 over the
four-year period for incoming students. Each year, the recipient
must maintain a grade point average of 3.0 or better and remain
in an undergraduate Chemistry or Biochemistry degree program
to continue to receive this joint scholarship award.
STUDENT INFORMATION
Name
_________________________________
Address_________________________________
_________________________________
Telephone _______________________________
Email
__________________________________
Career Interest
____________________________
PLEASE INDICATE YOUR INTENDED MAJOR:




Bachelor of Science in Chemistry
Bachelor of Science in Biochemistry
Bachelor of Science in Medicinal and
Pharmaceutical Chemistry
Bachelor of Arts in Chemistry
List up to five extra-curricular activities that most clearly
demonstrate the range of your interests. Indicate the dates of
involvement, and any leadership roles.
List your most significant academic achievements.
FAMILY INFORMATION:
Total number of dependent children in the family ________________________________
Parent's Occupation(s)
___________________________________________________
___________________________________________________
PERSONAL STATEMENT
On a separate sheet of paper, write a brief autobiography and summarize your goals.
THE FOLLOWING SECTIONS MUST BE COMPLETED BY A HIGH SCHOOL OFFICIAL
TO THE HIGH SCHOOL PRINCIPAL OR COUNSELOR:
Your responses to the following requests are
extremely important in qualifying this student for a
competitive scholarship award.
1. Please complete all pertinent sections.
2. Attach a 6- or 7-semester transcript of grades.
3. Attach any additional relevant information.
Include the student personal statement.
4. Return in a single mailing by March 31 to:
KATCHMAN SCHOLARSHIP
DEPARTMENT OF CHEMISTRY
UNIVERSITY OF DAYTON
300 COLLEGE PARK
DAYTON OH 45469-2357
STANDARDIZED TEST RESULTS
SAT
Date______________
Verbal _____________ Math_________
Date______________
Verbal _____________ Math_________
ACT
Date______________Composite _________
Date______________Composite__________
HIGH SCHOOL ACADEMICS
GRADE AVERAGE
CLASS RANK/TOTAL
______________
______________
What items, if any, are notable in the transcript or academic accomplishments of this student?
(AP or Honors courses, exceptional achievement, extenuating circumstances, etc.)
Are the standardized test results and the academic records consistent with your appraisal of this student's abilities?
Please write a short description of this student's special qualities. (You may attach an additional page.)
NAME OF SCHOOL OFFICIAL WHO COMPLETED THIS RECOMMENDATION:
_______________________________________________________________________________________
SIGNATURE
PRINTED NAME
SCHOOL NAME ____________________________________________________________________________
SCHOOL ADDRESS__________________________________________________________________________
CITY/STATE/ZIP
TELEPHONE
___________________________________________________________________________
_____________________________________ FAX ____________________________________