P E A C E R I V E R E N G I N E E R I N G S O C I E T Y
S C H O L A R S H I P A P P L I C A T I O N
The Peace River Engineering Society welcomes your application for our scholarship program. Being an organization of professional engineers and land surveyors, we are providing scholarships to only those students who desire to pursue an engineering degree.
While academic achievement is a factor in our scoring process, our review of your academic transcripts provides consideration both for difficulty of subject material as well as the course grade. In addition, SAT/ACT test scores, the essay portion of the application, type and level of involvement in extra curricular activities, references, work experience, and interviews are scored as well. So even if you are not a “straight A” student, your application will be seriously considered by our Review Committee.
Please provide all applicable information on this form. Should additional room be needed in a particular section, continue on a separate sheet of paper. Mark the appropriate section with “Continued on separate page” so that the reviewers know of the continuation.
The Peace River Engineering Society will keep academic and financial information submitted with this application confidential. We will publicize the names of the recipients upon award of the scholarships.
Whether or not you win a scholarship, the Peace River Engineering Society wishes you the best in your educational and professional endeavors.
PERSONAL INFORMATION
NAME:
Last:______First______Middle ______
ADDRESS:
No. & Street______City ______ZipCode ______
TELEPHONE:______BIRTH DATE: ______U.S. CITIZEN Y N
EMAIL: ______
COLLEGES APPLIED TO: (List in order of preference)
1.______Date Applied______
2.______Date Applied______
3.______Date Applied______
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CERTIFICATIONS
Applicant’s Certification
I hereby certify that the information included in this application is true and correct to the best of my knowledge. I understand that submitting non-factual information will automatically disqualify me from any consideration for a scholarship.
By submitting this application, I authorize my high school principal or counselor to make available to the Peace River Engineering Society information concerning my academic records.
Applicant Signature: ______Date: ______
Parent/Guardian Certification
I hereby certify I am the legal guardian of the applicant and that the information included in this application is true and correct to the best of my knowledge. I understand that submitting non-factual information will automatically disqualify the applicant from any consideration for a scholarship.
I authorize the release of the applicant’s academic records.
Parent/Guardian Signature: ______Date: ______
Counselor/Principal Certification
I hereby certify that the academic information, test scores, and summary of school activities as submitted on this application are correct and that the applicant has, to the best of my knowledge, applied to the schools listed in this application.
Signature / Title / DateSchool Name / Telephone
Address
City / State / Zip Code
Checklist
Signatures:
___ Applicant
___ Parent/Guardian
___ Counselor/Principal
Attachments
___ Academic Transcripts attached
___ Parent/Guardian Financial Statement Attached (page 7)
___ Essay Attached
___ Additional Information (if used)
TEST SCORES
Test Name: SAT: Math ______Verbal ______ACT: Math ______Verbal ______
EXTRA CURRICULAR ACTIVITIES
Technical Activities Sponsored by High School:
(Math Club JETS, Science Club, Science Fairs, etc.)
Activity Name: / # wk / Hr. Per week / School Year / Offices Held / Description of your level of activity in the club.10 / 11 / 12
EXTRACURRICULAR ACTIVITIES
Non-Technical Activities Sponsored by High School:
(athletics, cheerleading, service clubs, FFA, school publications, language clubs, non-math/science competition, etc.)
Activity Name: / # wk / Hr. Per week / School Year / Offices Held / Description of your level of activity in the club.10 / 11 / 12
Special Recognition or Academic Honors or Other Special Achievements:
(i.e., Honor Society, Academic Excellence Awards, etc. List all awards and activities not listed previously.)
Description / School Year / Basis for Award10 / 11 / 12
Non-High School Sponsored Activities:
(Church Activities, Scouting, Outside Service Clubs, etc.)
Activity Name: / # wk / Hr. Per week / School Year / Offices Held / Description of your level of activity in the club.10 / 11 / 12
Employment:
APPLICANT ESSAY
Please prepare a double-spaced typewritten essay (approximately 250 words) that answers the following: How I became interested in engineering. What type of engineering currently interests me and why. Upon graduation, how do I envision putting my engineering education to use (e.g. as designer of ______, working for a consulting firm, government agency, teaching, utility, corporation, etc.)
REFERENCES
Please attach up to four (4) personal reference letters from teachers, coaches, employers, pastors or other adults who are familiar with you.
ADDITIONAL INFORMATION
Should you have additional information that was not requested in this application, but you would like the Scholarship Review Committee to consider, please attach an additional typewritten page with this information. It is not required that you supply additional information; you will not be penalized for not submitting additional information.
INTERVIEW
Following our review of the scholarship applications, Peace River Engineering Society Scholarship Committee Members will select finalists from each school and conduct interviews at the schools to meet each of the finalists prior to awarding the scholarship.
CONFIDENTIAL FINANCIAL ANALYSIS
FOR PEACE RIVER ENGINEERING SOCIETY SCHOLARSHIP
This section should be completed by the parent, guardian or applicant (if self supporting).
1. Family’s gross annual income $ ______for year ______as reported to the IRS.
2. Number of other dependents that will be in college, junior college, vocational school, during the next four years, and the estimated annual amount to be contributed by the family toward their education (excluding the applicant for this scholarship.)
Number ______Total Annual Amount to be contributed by family ______
Name of dependent student Relationship to applicant School/Institution Name
(i.e. sibling, mother, father, etc.)
______
______
______
3. Name of applicant’s Father ______Is he living? ______
Father’s Address ______
______
Employer ______Position ______
4. Name of applicant’s Mother ______Is she living? ______
Mother’s Address ______
______
Employer ______Position ______
Complete the following only if applicable:
5. Name of applicant’s Legal Guardian ______
Guardian’s Address ______
______
Employer ______Position ______
6. I hereby certify that the above information accurately reflects my current financial status.
Signature ______Date ______
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