ACS-HACH GRADUATE & POSTDOCTEACHER SCHOLARSHIP
APPLICATION WORKSHEET
Application Deadline: April 1, 2014
We provide you this worksheet so you may view the questions asked and collect the information required for completing the online application form.This is not the application. You must complete and submit an online application by April 1, 2014 on the ACS Award Management Systemto be considered for the ACS-Hach Second Career Teacher Scholarship.
- CURRENT EDUCATION
University Name*
Where will you be obtaining your degree/certification?
Program Category*
Select the type of program that you will be enrolled in for the 2014-2015 academic year?
Teacher Certification
Masters in Teaching/Education
Enrollment Status*
What will be your enrollment status for the 2014-2015 academic year?
Part-Time
Full-Time
Completion Date*
When do you anticipate completing this program? Use the format: month year (e.g., May 2016)
Acceptance Letter*
Upload your acceptance letter here. To upload your letter:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page.
[5 MB(s) allowed]
- EDUCATIONAL BACKGROUND
Highest Degree Earned*
Undergraduate Major #1*
Select your undergraduate major from the following list. If you double-majored, select your first major and then proceed to the next question to select your second major.
Please reference the online form for the available list of majors.
Undergraduate Major #2
If you have a second undergraduate major, please select it from the following list of majors.
Please reference the online form for the available list of majors.
Advanced Degree Major #1
Select your advanced major from the following list. If you have more than one major, select your major and proceed to the next question to select your additional major.
Please reference the online form for the available list of majors.
Advanced Degree Major #2
Select your second advanced major from the list below.
Please reference the online form for the available list of majors.
Advanced Degree Major #3
Select your third advanced degree major from the list below.
Please reference the online form for the available list of majors.
"Other" Major - Please Explain
If you selected "Other" for any of your major(s), please list your major(s) below.
Please reference the online form for the available list of majors.
- TRANSCRIPTS
For each institution that you received a degree and/or certificate, please provide the institutional name, dates of attendance, and the official transcript.
Institution #1*
Dates of Attendance (Institution #1)*
Use the following format: start date year - end date year (e.g., 1998 - 2002)
Institution #1 GPA*
Enter your GPA on a 4.0 scale.
Institution #1 Transcript*
To upload your transcript:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page.
[2 MB(s) allowed]
Institution #2
Dates of Attendance (Institution #2)
Use the following format: start date year - end date year (e.g., 1998 - 2002)
Institution #2 GPA
Enter your GPA on a 4.0 scale.
Institution #2 Transcript
To upload your transcript:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page.
[2 MB(s) allowed]
Institution #3
Dates of Attendance (Institution #3)
Use the following format: start date year - end date year (e.g., 1998 - 2002)
Institution #3 GPA
Enter your GPA on a 4.0 scale.
Institution #3 Transcript
To upload your transcript:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page.
[2 MB(s) allowed]
Institution #4
Dates of Attendance (Institution #4)
Use the following format: start date year - end date year (e.g., 1998 - 2002)
Institution #4 GPA
Enter your GPA on a 4.0 scale.
Institution #4 Transcript
To upload your transcript:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page. [2 MB(s) allowed]
Angle brackets (>) are not allowed in responses. All HTML formatting should be removed from responses before submitting.
Certain e-mail addresses, for example 'John Doe <>' should be reformatted as ''.
- WORK EXPERIENCE
Profession*
Select the chemistry-related profession in which you have the most work experience.
"Other" Profession - Please Explain
If you selected other, please name the chemistry-related profession in the space below.
CV/Resume*
Upload a one page CV/resume. Make sure the resume highlights your educational and professional experience in the chemical disciplines. To upload your CV/resume:
1) Click on "Browse"
2) Select the file from your computer
3) Click on "Save As Draft" located at the bottom of this page.
[2 MB(s) allowed]
- PERSONAL NARRATIVE
Why Teach Chemistry?*
Describe why you want to teach chemistry. Please limit your answer to 1750 characters (approximately 250 words).
Personal Experience*
Describe how your personal experiences, formal or informal, prepared you to pursue a career in teaching. Please limit your answer to 1750 characters (approximately 250 words).
Professional Experience*
Describe how your professional qualifications will prepare you to pursue a career in teaching. Please limit your answer to 1750 characters (approximately 250 words).
Why This Scholarship?*
Describe how the ACS-Hach Second Career Teacher Scholarship will contribute to your career development. Please limit your answer to 1750 characters (approximately 250 words).
AdditionalComments
Please share anything else that you feel is relevant to or appropriate for the application. Limit your answer to 1000 characters (approximately 150 words).
- CONFIDENTIALLY STATEMENT
I hereby signify that all above information is true: I have an undergraduate degree in chemistry, have been accepted into a graduate program in education, and intend to teach high school chemistry.
Your Name*
Date*
* = Information Required
Page 1 of 5