Grants & Research Office
Office Use Only
Page 2 of 2
Date Received
Page 2 of 2
Applicant must complete all pages of this application.
PERSONAL INFORMATION
Page 2 of 2
Student ID: Application Date:
Full Legal Name: First: Middle: Last:
Page 2 of 2
Permanent address:
City/State/Zip:
Country:
Current address:
City/State/Zip:
Country:
Page 2 of 2
Local or campus phone: Cellular phone: Email address:
Gender: / Male / Female / Date of Birth:(Month/Day/Year)
Page 2 of 2
Racial Ethnic Background (Optional): Please feel free to check all that apply:
Black, Non-Hispanic / Hispanic / Native Hawaiian/Pacific Islander / American Indian or Alaskan NativeWhite, Non-Hispanic / Asian / Other:
Page 2 of 2
EDUCATIONAL INFORMATION
Cumulative GPA:
Total credits completed:
What is/are your intended major(s)?
Arts and Social Sciences
Applied Sciences
If undecided, please check this box:
PERSONAL ESSAYPersonal Essay: This section of the application helps us get to know you better. On a separate sheet of paper, please use the following instructions for writing your personal essay.
Instructions: Your essay cannot exceed 1,000 words, 12pt font, 1.5 spaced pages with 1 inch margins on both sides. In this essay you should discuss the following:
Identify a social justice-related problem that concerns you. This can be local, national, or an international problem.
o Define the problem.
o How would you address the problem?
o What are you doing to prepare yourself to work for social change?
o What do you hope to learn from this study tour that will help you improve your knowledge of social change?
o How will you contribute to social change in America?
ADDITIONAL INFORMATION
Letters of Recommendation and Deadline:All prospective applicants are required to secure one (1) letter of recommendation from a faculty member whose class you have taken. The Faculty Recommendation Form can be found on the Excel! Research Scholars Program website. Send the following e-mail link to your recommender: http://www.stthomas.edu/gro/students/excelresearch/eligibilityandapplication/. If the link does not work, copy and paste the URL into your browser. Request that your recommender fill out the Confidential Recommendation Form and send it directly to the Excel! Research Scholars Program office no later than the application deadline (January 10, 2017, 4:30p.m.).
______
Signature / Date
By signing this application, you affirm that the information therein is true and correct to your knowledge. Should the information you provide here be inaccurate or false, you understand that your application will no longer be considered, and if already admitted to the program, you could be subject to dismissal. This information will be kept confidential. Return the completed application to University of St. Thomas, Excel! Research Scholars Program, Aquinas Hall 319, 2115 Summit Avenue, St. Paul, MN 55105. Deadline January 10, 2017, 4:30p.m. Late applications will not be considered.
1. Completed Application Form (make sure you have answered all questions)
2.
Personal Essay
Transcript (unofficial is permissible)
One (1) letter of recommendation from one of your faculty members whose class you have taken.
Page 2 of 2