Department of Chemistry and Industrial Hygiene

DEPARTMENT OF CHEMISTRY AND INDUSTRIAL HYGIENE

University of NorthAlabama

Florence, AL 35632-0001

APPLICATION FOR

AN ENDOWED SCHOLARSHIP OR A NIOSH SCHOLARSHIP

FOR STUDENTS MAJORING IN CHEMISTRY* OR IN INDUSTRIAL HYGIENE

Date

Name

last first middle initial

Address

Zip

Phone Number (cell) (home) Date of Birth

High school or college last attended

Year graduated from high school (Intended) College major

What chemistry or industrial hygiene course(s) do you intend to take next semester?

(Note: Endowed scholarships are awarded to students majoring in Chemistry or Industrial Hygiene. NIOSH scholarship recipients, however, must major in Industrial Hygiene. This one form is used for both types of scholarships and the Scholarship Selection Committee considers each application for all the available scholarships for which the applicant is eligible.)

What goals have you set for yourself?

List significant extracurricular activities, positions of leadership, and honors you have received and indicate the year or years for that activity. (Attach an additional sheet if necessary).

(over)

This application is to be accompanied by a transcript. If you are or will be a freshman, attach a copy of your high school transcript. If your classification is above that of freshman, attach a copy of your college transcript. Also,you have the two attached recommendation forms to be completed by persons who know you and are able to evaluate your interests and qualifications in science. These forms should be mailed directly from the recommenders to the address given below. It is customary for applicants to provide their recommenders with stamped, addressed envelopes. Please list the names and addresses of your references below:

Name Address

Name Address

All endowed or NIOSH scholarships are not awarded each year. This application form and supporting documents material must be received by the Department of Chemistry and Industrial Hygiene by March 1st. Send application material to:

Chemistry and Industrial Hygiene Department Scholarships

UNA Box 5049

University of NorthAlabama

Florence, AL 35632-0001

or FAX: (256) 765-4958

Rev. 9/16

DEPARTMENT OF CHEMISTRY AND INDUSTRIAL HYGIENE

UNIVERSITY OF NORTHALABAMA

FLORENCE, AL 35632-0001

(TO BE COMPLETED BY APPLICANT)(print)

(last name) (first name) (M.I.)

The Family Educational Rights and Privacy Act of 1974 and its amendments guarantee students access to educational records concerning them. Students are also permitted to waive their rights of access to recommendations. The following signed statement indicates the wish of the applicant regarding this recommendation.

I waive my right to inspect the contents of the following recommendation.

I do not waive my right to inspect the contents of the following recommendation.

Applicant’s Signature

LETTER OF RECOMMENDATION

(TO BE COMPLETED BY THE RECOMMENDER)

The above-named student is applying for a Chemistry or Industrial Hygiene departmental scholarship. The recipients of these tuition scholarships are selected by a committee of faculty from the Department. Both scholastic achievement and financial need are considered in making the awards. We would appreciate your candid evaluation of the applicant's qualifications.

How long have you known this applicant and in what capacity?

Please rate the applicant in each area listed below:

 On the back of this page, or on a separate sheet, please provide a brief statement assessing the applicant's potential for success in college and qualifications for a tuition scholarship.

Name of recommender (please print or type)

Signature Date

Please return your recommendation to:

Chemistry and Industrial Hygiene Department ScholarshipsOR FAX: (256) 765-4958

UNA Box 5049

University of North AlabamaDeadline for all application material is March 1st.

Florence, AL 35632-0001

DEPARTMENT OF CHEMISTRY AND INDUSTRIAL HYGIENE

UNIVERSITY OF NORTHALABAMA

FLORENCE, AL 35632-0001

(TO BE COMPLETED BY APPLICANT)(print)

(last name) (first name) (M.I.)

The Family Educational Rights and Privacy Act of 1974 and its amendments guarantee students access to educational records concerning them. Students are also permitted to waive their rights of access to recommendations. The following signed statement indicates the wish of the applicant regarding this recommendation.

I waive my right to inspect the contents of the following recommendation.

I do not waive my right to inspect the contents of the following recommendation.

Applicant’s Signature

LETTER OF RECOMMENDATION

(TO BE COMPLETED BY THE RECOMMENDER)

The above-named student is applying for a Chemistry or Industrial Hygiene departmental scholarship. The recipients of these tuition scholarships are selected by a committee of faculty from the Department. Both scholastic achievement and financial need are considered in making the awards. We would appreciate your candid evaluation of the applicant's qualifications.

How long have you known this applicant and in what capacity?

Please rate the applicant in each area listed below:

 On the back of this page, or on a separate sheet, please provide a brief statement assessing the applicant's potential for success in college and qualifications for a tuition scholarship.

Name of recommender (please print or type)

Signature Date

Please return your recommendation to: OR FAX: (256) 765-4958

Chemistry and Industrial Hygiene Department Scholarships

UNA Box 5049Deadline for all application material is March 1st.

University of NorthAlabama

Florence, AL 35632-0001