ONSIGHT Application- Central Fall 2014 Survey

After responding to a series of demographic questions, please provide the following:

1. A personal statement of no more than 500 words that will help selection committee members answer the following questions about your application:

-- 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?

We recommend that you compose your statement in another format (e.g. MS Word) and cut and paste it into the text field below.

2. The names and contact information (including email addresses) for two references, at least one of whom should be a STEM instructor at SCC.

3. Please email to your ONSIGHT administrator, Josh Whorley, joshua.whorley@seattlecolleges.edu, the following items in PDF form:

-- An unofficial college transcript.
-- Two recommendation forms (or letters). Referees *may* email these directly to me, but please confirm with them that they have done so.

African

African American/Afro-Caribbean

Alaskan Native/Native American

Caucasian/White

Asian/Asian American

Latin American/Hispanic/Chicano

Other (please specify)

English is my second language.

I am a resident of the State of Washington.

I am a resident of public or Section 8 housing.

I am homeless or near homeless.

I am an international student studying under an F-1 or M-1 student visa.

I am a refugee.

I am a female student in engineering, physical science or math.

I am registered as a disabled student with our Disability Support Services.

Neither of my parents or guardians graduated from a four-year college or university.

Seattle Central Community College

North Seattle Community College

South Seattle Community College

Fall 2014

Winter 2015

Spring 2015

Summer 2015

Fall 2015

Biotechnology

Engineering

Mathematics

Chemistry

Computer Science

Geology

Biology

Physics

Other (please specify)

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* 1. First Name:

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* 2. Last Name:

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* 3. Student ID #:

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* 4. Home Address:

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* 5. Phone #:

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* 6. Email:

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* 7. Birthdate (MM/DD/YYYY)

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* 8. Ethnicity (check all that apply):

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* 9. Check all that apply:

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* 10. College:

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

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

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* 13. Current course of study:

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

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

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

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

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* 18. College & Community Activities:

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

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

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

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

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