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NSF CSMIS Scholarship Application Form 0

By Phyllis Diaz,2014-12-29 13:54
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NSF CSMIS Scholarship Application Form 0

    NSF CS/MIS Scholarship Application Form 0.9

    NATIONAL SCIENCE FOUNDATON SCHOLARSHIP

    for

    MANAGEMENT INFORMATION SYSTEMS

    COMPUTER SCIENCE, MATHEMATICS

    and

    ENGINEERING PHYSICS

    APPLICATION

SCHOLARSHIP ELIGIBILITY REQUIREMENTS:

    ; The applicant must be planning to be a full-time NSU student majoring in Computer Science or

    Management Information Systems.

    ; The applicant must have completed at least fifty semester hours of college work with an overall

    grade point average of at least 2.5 and 3.0 in any computer-related studies. ; Students must qualify for financial aid as determined by the U.S. Department of Education “Fee

    Application Federal Student Aid” (FAFSA) process. The Financial Aid Office will be happy to help

    you determine your eligibility if necessary.

    ; Students should be able to complete their degree plan within two years of the grant award. ; Students must be U.S. citizens, nationals or aliens admitted as refugees.

    ; While students are enrolled under the scholarship, they may be employed a maximum of fifteen

    hours a week in work outside their studies.

Amount of the Award:

    The total award will be for $3,125 per year for one year and is conditional on continuing to meet

    the requirements listed above and continued funding by NSF. Award will be applied toward tuition,

    fees, books, and other education-related expenses approved by the selection committee.

Information:

    Twenty-five competitive scholarships funded by the National Science Foundation will be awarded

    for the fall term. Proven academic and leadership abilities will be major factors in selection, with

    preference being given to minorities, women and persons with disabilities. For additional

    information about the NSF CS/MIS Scholarship Program at Northeastern State University contact:

    Dr. Michael D. Bolton, Professor of Mathematics and Computer Science, College of Mathematics,

    Science and Nursing, Northeastern State University, Tahlequah, OK 74464

    Phone: (918) 456-5511, Ext. 5846

    E-mail: matzen@cherokee.nsuok.edu

Application Submission:

    Number of scholarships remaining is limited.

    Please return application as soon as possible to:

    Rick Matzen

    Dept. of Math and Computer Science

    Northeastern State University

    Tahlequah, OK 74464

    Office: NET 323

    Phone: (918) 456-5511 Ext. 5846

    Application Packet must contain:

    1. Completed Application

    2. Official copies of all transcripts

    3. Three “Confidential Reference Forms” completed with optional letters attached.

     1

    Northeastern State University NSF CS/MIS Scholarship Application

PERSONAL DATA

    Name__________________________________________________

    Social Security Number ______-____-_________

    Birth Date _________________________________

    Spouse’s Name_________________________________(If applicable)

    Current Address:

    Street or Box Number______________________________________

    City____________________________ State______Zip___________

    Telephone Number_(______)_______-__________________

    Email Address ___________________________

    Alternate E-mail Address_____________________________

    Ethnic Group:

     ___White, non-Hispanic ___Asian or Pacific Islander

     ___Black, non-Hispanic ___Hispanic

     ___American Indian/Alaskan Native ___Other (explain) _________

    Parents Name(s) __________________________________________

    Address __________________________________________________

    City _____________________________ State ______

    Telephone Number_(______)_______-__________________

    1. EDUCATIONAL HISTORY AND PLANS:

    MAJOR: ________________________________________________

    EXPECTED GRADUATION DATE: ___________________________

    CURRENT COLLEGE GRADE POINT AVERAGE: ______________

     2 Northeastern State University NSF CS/MIS Scholarship Application

    List all high schools, colleges and universities attended. List most recent first.

    Address Dates of Hours Overall City/StateGPAMajor Field Attendance Earned School Name

2. ORGANIZATIONS (school, community, church, etc.):

    List your membership in organizations and/or elected or appointed offices held. List

    most recent first.

    Activity Organization Location Date

     3 Northeastern State University NSF CS/MIS Scholarship Application

3. VOLUNTEER WORK:

    List the organizations and groups where you have done volunteer work. Indicate the

    nature of the work, especially any leadership activities. List most recent first. Volunteer Work Organization Your Responsibility Date

     4 Northeastern State University NSF CS/MIS Scholarship Application

4. HONORS, AWARDS, AND SCHOLARSHIPS:

    List honors, awards and scholarships received while in high school and college. List

    most recent first.

    Honor/Award/Scholarship Organization Location Date

5. WORK EXPERIENCE: Start with your most recent.

     Dates Employed Hours

    Company, City, State Job Title From/To Per Week

    6. THREE REFERENCES: Give the information indicated below for three persons

    who are knowledgeable of your talents, abilities and character and are willing to

    serve as references for you. They should each complete one of the attached

    “Confidential Reference Forms” and, if you are among the finalists in the selection

    process, they may be contacted for further information.

    Name Job Title Address Day Phone

     5 Northeastern State University NSF CS/MIS Scholarship Application

7. CAREER ASPIRATIONS AND INTERESTS: Describe (1) your career goals

    and (2) how you expect your college education to help you attain your goals in 250

    words or less.

8. In submitting this application for review, I agree:

    1. That if I am granted an award and barring any unforeseen circumstances, I will

    continue my plan of study as indicated on this application. I understand I must

    complete at least 12 hours at NSU each semester and earn at least a 3.0 GPA to

    retain the scholarship.

    2. That the information included with this application is true to the best of my

    knowledge.

    ___________________________________ ________________

     Applicant’s Signature Date

     6 Northeastern State University NSF CS/MIS Scholarship Application

    CONFIDENTIAL REFERENCE FORM

    A part of the NSF CS/MIS Scholarship Application

Student’s Name: ____________________________________________________

    Instructions:

    A. Please circle the number in the right column that matches your evaluation of the

    above student. (1 is lowest, 5 is highest) Make any additional comments and sign.

     Place this reference in your business envelope, seal, sign across the seal, and

    return to the student to be submitted with their application. Thank you.

     LOW HIGH

    4. Attendance 1 2 3 4 5

    5. Dependability 1 2 3 4 5

    6. Confidence 1 2 3 4 5

    7. Cooperative 1 2 3 4 5

    8. Creativity 1 2 3 4 5

    9. Tact & diplomacy 1 2 3 4 5

    10. Willingness to learn & work 1 2 3 4 5

    11. Logical approach to problems 1 2 3 4 5

    12. Initiative 1 2 3 4 5

    13. Leadership qualities 1 2 3 4 5

    14. Motivation to academics 1 2 3 4 5

    15. Assertiveness 1 2 3 4 5

    16. Maturity 1 2 3 4 5

    17. Likeliness to graduate from college 1 2 3 4 5

    18. Overall evaluation 1 2 3 4 5

    Additional Comments: (Or, if you wish, you may attach a letter of recommendation.)

    Signature _________________________How long have you known the candidate?_____

    Title ________________________________________________Date

     7

    Northeastern State University NSF CS/MIS Scholarship Application

______________

    Name of Business

    _______________________________________________________

    CONFIDENTIAL REFERENCE FORM

    A part of the NSF CS/MIS Scholarship Application

Student’s Name: ____________________________________________________

    Instructions:

    A. Please circle the number in the right column that matches your evaluation of the

    above student. (1 is lowest, 5 is highest) Make any additional comments and sign.

     Place this reference in your business envelope, seal, sign across the seal, and

    return to the student to be submitted with their application. Thank you.

     LOW HIGH

    1. Attendance 1 2 3 4 5

    2. Dependability 1 2 3 4 5

    3. Confidence 1 2 3 4 5

    4. Cooperative 1 2 3 4 5

    5. Creativity 1 2 3 4 5

    6. Tact & diplomacy 1 2 3 4 5

    7. Willingness to learn & work 1 2 3 4 5

    8. Logical approach to problems 1 2 3 4 5

    9. Initiative 1 2 3 4 5

    10. Leadership qualities 1 2 3 4 5

    11. Motivation to academics 1 2 3 4 5

    12. Assertiveness 1 2 3 4 5

    13. Maturity 1 2 3 4 5

    14. Likeliness to graduate from college 1 2 3 4 5

    15. Overall evaluation 1 2 3 4 5

    Additional Comments: (Or, if you wish, you may attach a letter of recommendation.)

     8

    Northeastern State University NSF CS/MIS Scholarship Application

    Signature _________________________How long have you known the candidate?_____

    Title ________________________________________________Date

    ______________

    Name of Business

    _______________________________________________________

    CONFIDENTIAL REFERENCE FORM

    A part of the NSF CS/MIS Scholarship Application

Student’s Name: ____________________________________________________

    Instructions:

    A. Please circle the number in the right column that matches your evaluation of the

    above student. (1 is lowest, 5 is highest) Make any additional comments and sign.

     Place this reference in your business envelope, seal, sign across the seal, and

    return to the student to be submitted with their application. Thank you.

     LOW HIGH

    1. Attendance 1 2 3 4 5

    2. Dependability 1 2 3 4 5

    3. Confidence 1 2 3 4 5

    4. Cooperative 1 2 3 4 5

    5. Creativity 1 2 3 4 5

    6. Tact & diplomacy 1 2 3 4 5

    7. Willingness to learn & work 1 2 3 4 5

    8. Logical approach to problems 1 2 3 4 5

    9. Initiative 1 2 3 4 5

    10. Leadership qualities 1 2 3 4 5

    11. Motivation to academics 1 2 3 4 5

    12. Assertiveness 1 2 3 4 5

    13. Maturity 1 2 3 4 5

    14. Likeliness to graduate from college 1 2 3 4 5

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    Northeastern State University NSF CS/MIS Scholarship Application

    15. Overall evaluation 1 2 3 4 5

Additional Comments: (Or, if you wish, you may attach a letter of recommendation.)

    Signature _________________________How long have you known the candidate?_____

    Title ________________________________________________Date

    ______________

    Name of Business _____________________________________________________

     10

    Northeastern State University NSF CS/MIS Scholarship Application

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