Scholarship Application form

General Scholarship Application Form

To: College of Sciences
From: Student’s Name _____________________________ (please print)
Student’s Banner ID# @______________________

I am applying for the following scholarships.
Check only one. Separate application required for each scholarship.

__ College of Sciences Presidential Scholarship

__ College of Sciences Dean’s Scholarship

__ The Emily Zachry Ansley Endowed Scholarship

__ The Joseph J. Gdovin, Jr. Memorial Scholarship

__ The Dr. Harold G. Longbotham Endowed Scholarship

__ The Sam Madrid, Jr. Endowed Scholarship

__ The North Loop 410 Association, Inc. Endowed Scholarship

__ The Bernard P. Sagik Memorial Scholarship

__ The Dr. B. Thyagarajan Endowed Scholarship

__The USAA Foundation Scholarship

Student’s Signature __________________________________

Office of the Associate Dean for Academic Affairs
Biotechnology, Sciences and Engineering Building (BSE) 2.110 | (210) 458-4429

Please print neatly or type in black ink.
I. Personal Data
Name: __________________________________________________________________
Last First Middle

Address: ________________________________________________________________
City: __________________________ State: _______________ Zip Code: __________
Banner ID Number: @___________________ Date of Birth: ____/____/______
Month Date Year

Social Security Number: ___________________ Sex: M F
Home Telephone Number: _____________________ Cell: ________________________
UTSA E-mail Address: _____________@my.utsa.edu
Alternative E-mail Address: ________________________________________________
Texas Resident? Yes No U.S. Citizen or Permanent Resident? Yes No
Are you the first generation of your family to attend or graduate from an institution of
higher education? Yes No
Father’s Name: __________________________________________________________
Last First Middle

Father’s Employer/Occupation: _______________________________________
Mother’s Name: __________________________________________________________
Last First Middle

Mother’s Employer/Occupation: _______________________________________

Continued on next page.


II. Education
1. Major: _______________________ Minor:________________________
Classification:_________________ Transfer Student: Yes No
2. Date of application for admission to attend UTSA: _________________
3. Cumulative Semester Credit Hours Earned: ________________________
4. UTSA Semester Credit Hours Earned: ____________________________
5. Cumulative GPA: _________ UTSA GPA:___________
6. GPA for courses taken in the College of Sciences: __________
7. Expected Date of Graduation: ___________________________________
Month Year

8. Name and location of the high school from which you graduated:
Name: _________________________________________________________
Address: ______________________________ City: ____________________
State: __________________ Zip Code: ________________________
Incoming freshman: fill out spaces A-E
A. Class rank: _________ B. out of Total Class #:___________
C. High School GPA: ________ D. Total SAT: _____ V______ M______
E. Total ACT: _____V______M______

9. List all of the colleges and universities that you have attended in chronological order.
Name of School City and State Dates of Attendance



III. Activities and Achievements
List the activities in which you have participated:
College Activity Dates Participated Offices Held

High School Activity

Other Activity

List any awards that you have received:
Date Received
Name

List all scholarships and grants awarded to you:
Amount Renewable?
Name/Type
Yes No

Yes No

Yes No

Yes No

List the jobs that you have held over the last two years:
Employer Dates of Employment Approximate # of hours per week
Job


AUTHORIZATION FOR RELEASE OF INFORMATION
My permission is given to release transcripts of my academic record and other requested
information in consideration for the scholarships I have selected from the College of Sciences
General Scholarship list. I also authorize the University of Texas at San Antonio Student
Financial Aid Office to release my financial information to the College of Sciences. I understand
that this application will be made available only to those persons who need to see it in the course
of their duties.

I affirm that the information contained herein is true and accurate to the best of my knowledge
and belief.

Date: _____________________ Signature: _________________________________________


Student Essay

Complete the essay required for the selected scholarship.

Emily Zachry Ansley Endowed or Dr. Harold G. Longbotham Endowed Scholarships

In 600 words or less, write an essay on one of the following topics:
• A research or other activity related to the major in which you are participating.
• An activity or experience which motivated you in choosing your major.
• An issue or problem in your field of study.

North Loop 410 Association Inc. Endowed Scholarship

In 300 words or less, write a statement about your most distinctive honor.

______________________________________________________________________________


Recommendation Form for North Loop 410 Assoc. Endowed Scholarship

APPLICANT: Please complete the top section of this form and have a UTSA faculty member
complete the remaining sections.
Name: _______________________________________________________________________
Last First Middle

Banner ID Number @_________________________ Major_____________________________
I understand that this recommendation will not be made available to me or otherwise be publicly
disclosed except as required by law.

Date: _____________________ Signature: _________________________________________

RECOMMENDER: Please complete the following section of this form and return it directly to
the College of Sciences - Office of the Associate Dean for Academic Affairs (BSE 2.110).
Please type or print.

I. Personal Data
Name: _____________________________________________________________________
Last First Middle

Title: ______________________ Address: ________________________________________
Telephone Number: (____) _____________ E-mail Address: _________________________



II. Questions

1. Please indicate how long and in what capacity you have known the applicant.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

2. Please rate the following characteristics of the applicant on a scale of 1 to 10 with 1 being
the lowest rating and 10 the highest rating. Assign a rating of zero to indicate that you have
no basis for judging a particular characteristic.

Characteristic Rating
Intellectual Ability

Motivation

Creativity

Maturity

Oral Communication Skills

Written Communication Skills

Knowledge of his or her field

Ability to work with others

Ability to work independently

Overall Rating

3. Does the applicant's academic record reflect his or her true ability? If no, please
explain.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Date: _____________________ Signature: _________________________________________


Scholarship Application form

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (13)

Ähnlich wie Scholarship Application form

Ähnlich wie Scholarship Application form (20)

Mehr von UTSA College of Sciences

Mehr von UTSA College of Sciences (14)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Scholarship Application form