AFCEA STEM SCHOLARSHIP APPLICATION - 2017

ERIE CANAL CHAPTER

HIGH SCHOOLSENIOR CANDIDATE APPLICATION

1. CANDIDATE:

Name: ______

Permanent Home Address: ______

______

Mailing Address: ______

______

Mother’s Name:______

Mailing Address: ______

______

Father’s Name: ______

Mailing Address: ______

______

Student’s email address: ______

(This email will be used to inform you if there are any issues with your application)

Telephone Numbers: (Home) ______(Cell) ______

(School) ______

AFCEA MembershipYes ( )Own ( )Parent ( )Membership # ______

(For informational purposes only, not a prerequisite)

General Info:

High school name ______

Planned college/University name ______

Principal or Guidance Counselor name ______

High School Address: ______

______

Telephone: ______

2. APPLYING FOR: Undergraduate Scholarship (Full-Time)( )

Minority Scholarship( ) (see Scholarship Announcement for definition)

NOTES:

1. Additional pages may be attached if desired. Reference the attached information by citing the appropriate paragraph number.

  1. A personal or telephone interview may be requested by the evaluation committee.
  2. In the event of extenuating circumstances, it may be necessary for Erie Canal Chapter, to request an applicant to provide the curriculum list for their major in order to determine if the major meets the AFCEA STEM criteria
  3. Information in this application must betyped or computer generated.

AFCEA is a member-based, non-profit association that focuses on cyber, command, control, communications, computers and intelligence to address national and international security challenges.

Candidates for Erie Canal Scholarships need to be engaging in a course of study that will result in a degree in: science, technology, engineering and mathematics (STEM) disciplines focused on information technology, cybersecurity, telecommunications and electronics supporting the defense, homeland security and intelligence communities.

3.EDUCATION GOAL/INTERESTS (Degree goal, major & minor subjects, and other interests):

4.CLASS STANDING: ______

GRADE OR GRADE POINT AVERAGE: ______

SAT scores / dates______

ACT scores / dates______

GRE scores / dates______

Other applicable scores/dates______

  1. TRANSCRIPT – Please attach a copy of official transcript

6. SCHOLASTIC HONORS, AWARDS AND HONORARY ORGANIZATIONS (include all offices and/or positions in honorary organizations. Please be specific.):

7. SPECIAL SCIENTIFIC AND TECHNICAL SKILLS, INTERESTS AND ACCOMPLISHMENTS. (include scientific and technical hobbies or projects in which you have participated and the extent of participation. Please be specific.):

8. LETTERS OF REFERENCE (Have 2 letters of reference sent directly to the AFCEA Erie Canal Chapter Secretary. They should be mailed by your reference sources. Include at least one from a faculty or staff member from your current school/college. Other references should specifically relate to your involvements in items listed above. Avoid reference from peers/contemporaries):References must be dated and signed. Follow up with your sources to be sure that they have sent your reference letters. If you are missing letters your application will not be submitted for review. You may send an email to to see if your reference letter was received.

List of reference sources, including name and position:

1.

2.

APPLICANT’S SIGNATURE:DATE:

______

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