Before you begin your application:

Due Date: May 30, 2014 at 5pm.

On this form, you enter your contact information, personal statement, and your references contact information.

Please note: You CANNOT save data to this form! Before starting this application, you should have your personal statement and the contact information for your recommendation letters ready.

Turn in your other application materials documents (such as transcripts, FAFSA) directly to Jake Ashcraft in RSB 188 (or via email).

Be sure to fill out the demographic information at the bottom of the form - only complete applications will be accepted.

To review, your total application must include the following information:

1. A personal statement of 250 to 500 words. Please compose this in a word processing program such as Microsoft Word, and then paste it into the field in the application below. Your statement should help selection committee members answer the following questions:

• Does the student demonstrate a desire to succeed in STEM classes?
• Is the student focused on academic and personal goals?
• Does the student clearly describe why he/she is enrolled in STEM?
• Does the student make a well-supported case for receiving an award?

2. The names and contact information for two references, at least one of whom should be affiliated with your college. You must provide us with their contact information by May 30. The actual recommendations are due at 5pm on Friday, June 6, either emailed to jacob.ashcraft@seattlecolleges.edu (PDFs preferred) or submitted as hard copies to Jake Ashcraft in RSB 188.

3. An unofficial college transcript in PDF form, emailed by 5pm on May 30 to Jake Ashcraft (jacob.ashcraft@seattlecolleges.edu) or submitted as a hard copy to Jake Ashcraft in RSB 188 by 5pm on May 30.

4. The first page of your SAR from your completed FAFSA, emailed by 5pm on May 30 to Jake Ashcraft (jacob.ashcraft@seattlecolleges.edu) or submitted as a hard copy to Jake Ashcraft in RSB 188 by 5pm on May 30.

* 1. First Name:

* 2. Last Name:

* 3. Please provide a personal statement of 250 to 500 words. We recommend composing your statement in a word processor and cutting and pasting to the box below.

* 4. Contact Info for Recommendation #1 (Name, Title, Email, Phone):

* 5. Contact Info for Recommendation #2 (Name, Title, Email, Phone):

* 6. Student ID #:

* 7. Home Address:

* 8. Phone #:

* 9. Email:

* 10. Birthdate (MM/DD/YYYY)

* 11. Ethnicity (check all that apply):

* 12. Check all that apply:

* 13. College:

* 14. I am/will be a full-time student for the following quarters (check all that apply):

* 15. List the four-year universities where you plan to apply for transfer, and indicate approximately when you plan to transfer.

* 16. Current course of study:

* 17. Total credits completed as of Winter 2014 (see “Cum: Cr Earn” at bottom of transcript):

* 18. Your college level GPA (“CLM: GPA” on bottom right corner of your transcript):

* 19. Education experience:
(Names and dates of schools attended, degrees pursued and completed, cumulative GPAs for each):

* 20. Two most recent jobs (employers, dates, job titles):

* 21. College & Community Activities:

* 22. Hours per week you spend working/work-study:

* 23. Hours per week you spend volunteering with on or off-campus organizations:

* 24. I understand that this application will not be considered unless all required materials are attached, and the application is signed and dated.

I realize that every eligible applicant will not receive an award.

I also understand that applications are confidential and that my application materials will not be returned.

I also hereby swear that all information provided in my application is true and complete to the best of my knowledge. If determined that any of the information I provided is false, altered or forged, I understand that my application will not be considered and if awarded a scholarship, the award rescinded.

In addition, the misconduct maybe reported to the Vice President for disciplinary sanctions under WAC 132F-121-110.

Please provide your electronic signature below:

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