AMERICAN SOCIETY OF HEATING, REFRIGERATING AND

AIR-CONDITIONING ENGINEERS – Kansas City Chapter

HIGH SCHOOL SCHOLARSHIP APPLICATION

PERSONAL DATA (Please type or print in ink; Attach separate sheets if needed)

Last Name, First, MI Sex (M/F) Contact Telephone No. E-mail

Student’s Home Address City State Zip Code

Birthplace Age Date of Birth Citizenship

Mother’s Name Occupation

Father’s Name Occupation

Address of Parent or Guardian

EDUCATION

High School Location Cumulative Grade Point Average (4 pt. scale)

College or University Planning to Attend Location Major Subject

ACTIVITIES

High School Activities and Hobbies

List below any membership or offices held in professional or honorary societies

Office Society

1.

2.

3.

4.

Courses - List below any engineer related courses taken while in high school

PROFESSIONAL DATA (Supply a brief resume of your work experience in chronological order)

Job Title Duties Length of Employment

PROFESSIONAL GOALS

What is your particular interest in the engineering profession? (Answer 200 words or less)

Do you have a special interest in HVAC(heating, ventilating, and air conditioning) and to what extent, if any, have you participated in activities relating to HVAC ? Do you plan to be involved with ASHRAE? (Answer 200 words or less)

________________________________________________________________________________________________________________________

Why should we award this scholarship to you? Please justify financial need.

REFERENCES (Please list two names and addresses. Include one letters of recommendation with application.

1. Teacher or Faculty Advisor Address

2. Business Person or Other Address

Criteria for Applicants

1. Acceptance into an Engineering or Engineering Technology curriculum accredited by the Accreditation Board for Engineering and Technology (ABET) or other accrediting agency recognized by ASHRAE. Students pursuing an associate degree in Engineering Technology need not be enrolled in an ABET-accredited program, but must be pursuing a course of study, which traditionally has been a preparatory curriculum for a career in HVAC&R.

2. A cumulative grade point average (GPA) of at least 3.5 on a scale where 4.0 is the highest and/or a class standing of no less than the top 30% evidenced by an official transcript of grades or statement from a school administrator.

3. One letter of recommendation form a teacher, advisor or current/past employer.

4. Plans to join local student ASHRAE branch, if available. Visit www.ashrae.org/students for a list of schools with an active ASHRAE student branch.

5. Potential service to the HVAC&R profession.

6. Need for financial assistance.

7. Leadership ability, character and work ethic.

8. Scholarship recipient shall provide course schedule for fall semester, indicating engineering or pre-engineering courses.

I believe all of the above information to be true and complete and I hereby apply for the American Society of Heating, Refrigerating and Air-Conditioning Engineers – Kansas City Chapter Scholarship. I certify that I am not receiving full funding for my education from an employer, any branch of the Armed Services or other organization. I authorize ASHRAE to obtain and review my academic records (including but not limited to official transcripts). In signing below, I agree to hold ASHRAE – Kansas City harmless from any and all liability for damage, injury, or loss sustained by me in connection with this application, including but not limited to, the acquisition by ASHRAE – Kansas City of my academic records.

Date Signature of Applicant

Signature of Parent or Guardian (if applicant is under 18 years of age)

Page 3 of 3


HIGH SCHOOL ENGINEERING SCHOLARSHIP APPLICANTS:

DEADLINE – Friday, May 6th, 2016

Mail complete application in one envelope postmarked on or before the deadline to:

PKMR Engineers

c/o: Ann Peratt

13300 W. 98th St.

Lenexa, KS 66215