Annual Meeting Student Scholarship Application and Instructions

Scholarship Application must be typed or printed neatly and include all required information. Applications may be printed from www.eatrightvt.org.

Send completed application to:

If you would like to mail your form, contact the CPI Chair Elect at the above email address for a mailing address.

Applications are due by March 21. Electronic applications will be accepted with proof of enrollment in an academic program by having the application electronically forwarded to the CPI Chair Elect from a member of the academic program’s faculty.

Note: Incomplete or late applications will not be considered; no exceptions will be made.

No application materials will be returned. You are encouraged to keep a copy for your own records.

Notification of status will be sent to all applicants by March 27.

The scoring of the applications will follow the matrix below. Only completed applications will be scored. The applicants with the highest scores will be awarded the scholarship to attend the program. The CPI-Chair Elect will contact scholarship applicants and winners with the results. Scholarship winners will be recognized as part of the VAND annual meeting program materials and/or at the awards portion of the annual meeting.

Application complete? Yes: proceed with scoring.

Criteria / Points Possible / Points Awarded
Academy Member / 5 points if member
Memberships and Activities / 1 point for each
Community Service and Activities / 1 point for each
Honors and scholarships / 1 point for each
Career Goals Essay / Writing: 5 points
Answered question: 10pts
Total points:


VAND Annual Meeting Student Scholarship

PLEASE TYPE ALL INFORMATION

1. PERSONAL DATA

a. Name: / Mr./Ms.
Last / First / Middle
b. Present Address: / c. Permanent Address:
d. Telephone: Day: / ( ) / Evening: / ( )

2. ACADEMY MEMBERSHIP

a. I am a member of the Academy of Nutrition and Dietetics / No / Yes / If yes, enter Number

3. EDUCATION PROGRAM CATEGORY

Check only one box for the program you will be enrolled in for 2012-2013.

Undergraduate Program

What is the expected date of completion/graduation?

List month and year / Are you attending full-time / or part-time?

Graduate Program

Master's Degree

Must have applied to or be enrolled in a master's degree program and intend to practice in dietetics.

OR

Doctoral Degree

Must have applied to or be enrolled in a doctoral degree program and intend to practice in dietetics;

What is the expected date of completion/graduation?

List month and year / Are you attending full-time / or part-time?


4. MEMBERSHIPS AND ACTIVITIES

(List organizations, offices held and major accomplishments)

5. COMMUNITY SERVICE and/or EXTRACURRICULAR ACTIVITIES
(List dates of participation with most recent first.)

Date

6. HONORS and SCHOLARSHIPS

7. CAREER GOALS

In 100 words or less, please describe your professional goals and how receiving this conference scholarship will help you achieve your goals. How does the program schedule for this year’s VAND meeting align with your interests and goals?

8. CERTIFICATION

All of the information in this application is true and complete to the best of my knowledge.

Signature of Applicant / Date
Signature of Program Director or Academic Advisor:
Name:______
Title: ______
Program: ______