2017-2018
Department of Physical Science Scholarships
Application Deadline: March 1, 2017
1.
CATEGORY – Indicate below your class status for the upcoming academic year:
Freshman
Sophomore
Junior
2.
PERSONAL DATA
Name (First Ml Last)
Senior
T#
US Citizen?
Perm. US Resident?
Yes
No
Yes
No
Alien Registration No. (If applicable)
Permanent Mailing Address
Address at School
City
State
Zip
Phone
City
Preferred Email address
High School Location (City, State)
Major Concentration (i.e. Healthcare,
Professional, Teaching, etc.)
College GPA (Include basis, e.g. 3.5 out of 4.0)
out of
Degree Expected:
Zip
Phone
If a scholarship is awarded, which address would you like your offer letter to be
mailed to:
Permanent Mailing Address
Address at School
3.
EDUCATION
High School Name
Current Declared Major at SUU:
State
Citizenship, if not US?
Year Graduated
Other College or University Attended (If applicable)
Location (City & State)
Major Subject:
Year:
Degree:
Year:
Other GPA (Include basis, e.g. 3.5 out of 4.0)
out of
Department of Physical Science scholarships can be applied to tuition only. Do you anticipate receiving and accepting any new/continuing scholarships awarded by SUU (i.e.
President's, Founder's, Dean's, Centurium, GHA, Sterling, Non Resident, etc.) that could affect the eligible scholarship amount you receive from the Department?
No
Yes
If you answered yes, please indicate Scholarship Name and anticipated amount:
What are your anticipated plans after graduation from SUU? (i.e. Medical School, Pharmacy School, Graduate School, Teaching, Work in Field, etc.)
SUBMIT ONLY ONE APPLICATION. YOU WILL BE CONSIDERED FOR ALL SCHOLARSHIPS FOR WHICH YOU QUALIFY.
ELIGIBILITY – To be eligible, an applicant must satisfy the following requirements
1. Must be a full time student at Southern Utah University
2. Must be a declared major in one of the degrees offered by the department of physical science or be a declared major in the field specified by
specific scholarship donors.
3. Is not receiving full funding for education from another organization (e.g. students receiving full reimbursement from an employer).
ALL APPLICANTS
APPLICATION FORM
STATEMENT OF ACTIVITIES, HONORS, LEADERSHIP – LIST – not an essay – school and community activities, including years in which you
participated. High school activities may be included if you are currently a high school or freshman student. Identify leadership positions you have held. List
any honors or awards you have received.
PROFESSIONAL DATA – Supply a brief resume of any work experience, including your duties, starting and terminating dates, salary and any other
pertinent information. Briefly describe any research projects, design projects or design teams in which you have participated.
INTERESTS & HOBBIES –Briefly describe any special interests, hobbies, sport or musical accomplishments.
APPLICANT’S STATEMENT – A statement or essay written by the applicant, NO MORE THAN ONE SINGLE-SIDED DUBLE-SPACED TYPEWRITTEN
PAGE, telling
a) why you would like to be a physical science major (e.g. chemist, geologist, etc.)
b) how you believe you will make a difference as a physical science major (e.g. chemist, geologist, etc.)
c) what influenced you to study physical science (e.g. chemistry, geology)
d) what you anticipate your future plans/goals to be
STATEMENT OF ACTIVITIES, HONORS, LEADERSHIP - List school and community activities, including years in which you participated. High
school activities may be included if you are currently a high school or freshman student. Identify leadership positions you have held. List any
honors or awards you have received.
DATES
ACTIVITY
PROFESSIONAL DATA – Supply a brief resume of any work experience, including your duties, starting and terminating dates, salary and any
other pertinent information. Briefly describe any research projects, design projects or design teams in which you have participated.
Dates
Salary
Employer/Description of Duties
INTERESTS & HOBBIES – Briefly describe any special interests, hobbies, sport or musical accomplishments.
APPLICANT”S STATEMENT – A statement or essay written by the applicant, NO MORE THAN ONE
SINGLE-SIDED DOUBLE-SPACED TYPEWRITTEN PAGE, telling
• why you would like to be a physical science major (e.g. chemist, geologist, etc.)
• how you believe you will make a difference as a physical science major (e.g. chemist, geologist, etc.), what are your career
goals
• what influenced you to study physical science (e.g. chemistry, geology)
• what you anticipate your future plans/goals will be