BMM Chicago Scholarship Application for Spring Semester 2012

ThankyouforyourinterestintheBariaMitraMandalofChicagoannualscholarship.Allrequestedinformation mustbereceivedbyNovember 30,2011.If youhaveanyquestions,pleaseemail .

APPLICANTDATA

Applicant’sName:

LastFirstMiddleInitial

PermanentAddress:

HouseNumber & StreetNameCityStateZipCode

EmailAddress:

HomePhone:() Alternate/Cell:()

Age:yrsDateofBirth://_

AreyouaUnitedStatesCitizenorPermanentResident? YesNoIfno,immigrationstatus:

Schoolyouplantoattendin 2012:

Degreeareyoupursuing:

CityState:

Willyoubeenrolledatleast6credithoursatanaccrediteduniversityorjuniorcollegein2012? YesNo

EDUCATIONALBACKGROUND

Schoolyoucurrentlyattend:

Currentgradeorstanding:

CityState:

GPA:

IndicateScale:4.05.0ClassRank: / (a copy of your current transcript will be required)

SATScore: / 2400 CompositeACTScore: /36[MarkN/Aifyouhavenottakenspecifictest]

Pleaselistallactivitiesbelowwhereapplicable.If necessary,youmayattachanadditionalsheet.

SCHOOLSPONSOREDEXTRA‐CURRICULARACTIVITES
ACTIVITY/ORGANIZATIONNAME / POSITIONORROLE / YEAR
COMMUNITYBASEDACTIVITES
ACTIVITY/ORGANIZATIONNAME / POSITIONORROLE / YEAR

NOTE:BELOWSECTIONONLYFORWORKFORWHICHYOUWEREPAIDAWAGEORSALARY:

WORKEXPERIENCE
EMPLOYERNAME
CITYSTATE/PHONENO.
SUPERVISOR’SNAME / JOBTITLE / DATESOFEMPLOYMENT

FREERESPONSEQUESTIONS

1.Brieflyexplainifyouhaveenduredany(non‐financial)hardshipsthatyouhavehadtoovercome:

2.Brieflyexplainyouracademicandcareergoals:

3.Brieflyexplainanystepsyouhavetakentoprepareforyourintendedcareer:

4.List5wordsthatbestdescribeyourpersonalityorcharacter:

5.Pleaseattachanessayofnomorethan500wordsansweringthefollowingquestion.

Whatinfluencedoyouseeyourculturehavinginaccomplishingyouracademicandcareergoals?

ADDITIONALREQUIREMENTS

1.Lettersof recommendation.Pleaseincludetwolettersofrecommendationsealedinenvelopeswiththeauthor’s signatureacrosstheseal.

a)Onemustbefromaschoolofficialwhoisfamiliarwithyouracademicperformance.

b)Onemustbefroma non‐relativecommunitymemberfamiliarwithyourcharacter.

2.Transcripts:Pleaseincludea copyofyouracademictranscript.

3.SAT& ACTScores:Pleaseincludecopiesoftheoriginalscoretranscript.

  1. You can email your completed application and essay to y Nov 30th 2011. Please mail your supporting documents to following Address (should be postmarked by November 30th 2011) .

BMM Chicago ScholarShip

c/o Ashish Dharia

204 Southwicke Drive

StreamwoodIL60107

  1. If you want your supporting documents back then please provide self addressed stamped return envelop with your application. In case we don’t receive the return envelope then all supporting documents will be shredded after scholarship is awarded.
  1. For more information please refer to "Eligibility Criteria" on bariachicago.org website.