CSU Robert Noyce Teacher

CSU Robert Noyce Teacher

Scholarship Application Form

Application may be downloaded as a word document from

Please type all responses. Complete instructions are on the final page.

Application type:□ New Scholarship□ RenewalScholarship

Student type:□ Current CSU Student□ New Transfer Student

Citizenship status:□ U.S. Citizen□ Permanent Res. Alien

Applicant Name
Last, First M.I.
CSU ID Number / Phone Number
Class (Check one) / □ Junior (at least 60 credit hrs)
□ Senior (at least 90 credit hrs)
□ Post baccalaureate / Post baccalaureate students list field of undergraduate major
Email Address
Home Address
Declared Major

In addition to completing this application, all students mustverify eligibility as a U.S. citizen or national by submitting a 2016-2017FAFSA application form using the federal school code for CSU (001561) or presenting a valid U.S. passport. Only students already admitted for spring 2017 will be considered for scholarships. The following eligibility checklist is meant to help you verify your eligibilityfor the scholarship and the completeness of your application. Please check each box as you verify that requirement or complete that step in the application process.

I have applied for admission to Columbus State University or have already been admitted to the University.
I have submitted a completed 2016-2017FAFSA application form listing CSU as the school, OR I have a valid U.S. passport that I will present to the program director.
I plan to be enrolled at CSU on a full-time basis in fall 2016 (at least 12 semester credit hours)
I have completed at least 30 semester hours of credit at CSU with a CSU grade point average of 3.0
or
I have fewer than 30 semester hours of credit at CSU and my overall grade point average is at least 3.0-.
I will be majoring in a qualified degree program(UTeach program orSecondary Education Track in one of the following programs: BA Biology, BA Chemistry, BS Earth & Space Science, BA Mathematics, BS Mathematics) or have a STEM degree and will pursue secondary certification as a post-baccalaureate student.
I have requested 2 recommendation letters from college or university faculty using the attached Recommendation Request Form (for renewals, one letter must come from the assigned Noyce program mentor)
I have attached a program of study verifying that I can complete all degree requirements and student teaching by May 2018.
I have completed all parts of the application listed on page 2

Applicant Educational Accomplishments

Applicant Name:

Scholarship selection criteria:

•Ability to complete an academically rigorous program (as evidenced by GPA, test scores, and teacher recommendations)

•Demonstrated dedication to teaching (as evidenced by student essay as well as academic and extra-curricular activities)

•(If applying for renewal) Record of active participation in program related events and activities including Teaching Connections Seminars, STEM Honors Camp, tutoring, peer instruction and other service learning experiences

•Good communication skills

•Encourage diversity

•Balance of enrollments across qualified degree programs

•A strong enthusiasm and commitment to complete a degree in an eligible program

•Level of financial need based upon the expected family contribution obtained by the completed FAFSA form

Academic and Extra-curricular Activities: (Please list your significant academic and extra-curricular activities undertaken since you started college, in their order of importance. Please include any service learning activities.)

Disability status. As the selection criteria indicate, a goal of the Robert Noyce Teacher Scholarship program is to increase the participation of persons with disabilities in the teaching profession. If you have a qualifying disability you may choose to indicate it below but you are not required to do so. Appropriate documentation from the Office of Disability Services may be required to support a claim of a disability.

□ Visual impairment□ Hearing impairment

□ Mobility impairment□ Other: ______

Essay. Please attach a typed essay of not more than 500 words discussing why you want to become a math or science teacher.

Program of Study. Please attach a program of study showing, semester by semester, the courses you plan to take to meet teaching certification requirements and complete your major requirements.

Signature. By signing below, I attest that the information I have provided is accurate and request consideration of my application for the CSU Robert Noyce Teachers Scholarship. I understand that failure to fulfill the teaching service requirements will require me to repay the scholarship funds and appropriate interest.

Signature / Date

Rev. 1/17