Before you begin your application:

Please complete the following questions to begin your application. Note that in addition to these questions, you will also need to send an unofficial copy of your transcript along with your personal statement to Ann.Murkowski@SeattleColleges.edu. In addition, you should ask your two references to forward their letters of reference to this same address. All materials must arrive by April 18, 2016.

Thank you for your interest in our program, and good luck! All applicants will be notified once the selection process is complete. Finalists will be invited to interview, either in person or by phone, before the final awards are made.

First Name:

Question Title

* 1. First Name:

Last Name:

Question Title

* 2. Last Name:

Which college do you currently attend?

Question Title

* 3. Which college do you currently attend?

Student ID #:

Question Title

* 4. Student ID #:

Home Address:

Question Title

* 5. Home Address:

Phone #:

Question Title

* 6. Phone #:

Email:

Question Title

* 7. Email:

Birthdate (MM/DD/YYYY)

Question Title

* 8. Birthdate (MM/DD/YYYY)

Ethnicity (check all that apply). Note that this information does not affect your application; it is used to provide data to our funding organization, the National Science Foundation.

Question Title

* 9. Ethnicity (check all that apply). Note that this information does not affect your application; it is used to provide data to our funding organization, the National Science Foundation.

Check all that apply:

Question Title

* 10. Check all that apply:

I am/will be a full-time student at my community college for the following quarters (check all that apply):

Question Title

* 11. I am/will be a full-time student at my community college for the following quarters (check all that apply):

List the four-year universities where you plan to apply for transfer, and indicate approximately when you plan to transfer. (Note that to be eligible for this program, you must have at least one full year left at your community college.)

Question Title

* 12. List the four-year universities where you plan to apply for transfer, and indicate approximately when you plan to transfer. (Note that to be eligible for this program, you must have at least one full year left at your community college.)

Current course of study:

Question Title

* 13. Current course of study:

Total credits completed as of Winter 2016 (see “Cum: Cr Earn” at bottom of transcript):

Question Title

* 14. Total credits completed as of Winter 2016 (see “Cum: Cr Earn” at bottom of transcript):

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

Question Title

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

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

Question Title

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

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

Question Title

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

College & Community Activities:

Question Title

* 18. College & Community Activities:

Hours per week you spend working/work-study:

Question Title

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

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

Question Title

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

Recommendation #1 (Name, Title, Email, Phone):

Question Title

* 21. Recommendation #1 (Name, Title, Email, Phone):

Recommendation #2 (Name, Title, Email, Phone):

Question Title

* 22. Recommendation #2 (Name, Title, Email, Phone):

Please click the boxes below to indicate that you have read, understood, and agreed to all of the items below.

Question Title

* 23. Please click the boxes below to indicate that you have read, understood, and agreed to all of the items below.

T