North Carolina Mathematics and Science Education Network
(NC-MSEN)
Pre-College Program
William Randolph Hearst Foundation Scholarship Application Form
Please submit in one envelope.
A completed application form.
An official high school transcript through the most recent grading period of the senior year.
A one page essay describing how the NC-MSEN Pre-College Program has contributed to your life and education, and how receiving this scholarship would benefit your future mathematics, science, technology, or engineering endeavors.
Two sealed letters of recommendation from a teacher, counselor, or principal.
The completed participation validation form signed by the NC MSEN Pre-College Program coordinator.
Send completed scholarship application postmarked no later than March 15, 2007 to:
Rita L. Fuller
Associate Director, NC MSENPre-College Program
UNCCenter for School Leadership Development
140 Friday Center Drive
Chapel Hill, NC 27517-9495
Telephone (919)966-3202
Information and requirements to be considered for the Hearst Scholarship:
A $5,000 scholarship to a NC-MSEN Pre-College Program graduating senior.
Applicants are eligible to receive one scholarship award only.
Application is limited to NC-MSEN Pre-College Program students who have fully participated in the NC-MSEN Pre-College Program for 5 or 6 years.
Applicants must have a current cumulative GPA of 2.5 or above.
Applicant must have a 900 or greater on the SAT.
Applicant must be admitted to a four year institution and plan to major in science, mathematics, technology, or engineering.
Applicant must participate in an interview with the scholarship committee.
NC-MSENPre-College Program
William Randolph Hearst Scholarship Application Form
1. Name______
(First)(Middle)(Last)
2. Home Address______
(Street/Box)
______
(City) (State) (Zip)
3. Home Telephone ( )______E-mail______
4. Date of Birth ______
(mm/dd/yy)
5. Parent or Guardian’s name ______
6. Address of parent or guardian (if different from home address)
______
7. Home town newspaper______
8. High school name ______
9. High school address______
(Street/Box) (City/State) (Zip)
______
(Telephone Number)
11. High school graduation date ______
(Month) (Year)
12. Applicant’s high school rank ______out of ______students.
13. Cumulative high school GPA through most recent grading period
GPA ______based on a ______point scale.
14. College entrance examination scores (ACT and/or SAT)
SAT______ACT______
15. High school honors received
______
______
______
______
15. High school extra-curricular and community activities (include any offices held)
______
______
______
______
16. Name of college/university you plan to attend______
Address______
(Street/Box) (City/State) (Zip)
17. Student’s signature______Date______
18. Parent/Guardian’s signature______Date______
My signature serves as permission for NC-MSEN Pre-College Program to publish my child’s name and photos in the event he/she is awarded the Hearst Scholarship
Please submit application no later than March 15, 2007.
North Carolina Mathematics and Science Education Network
(NC-MSEN)
Pre-College Program
William Randolph Hearst Foundation Scholarship Application Form
Participation Validation Form(to be filled out by applicant’s NC-MSEN Pre-College Program Coordinator)
______has fully participated in the NC-MSEN
(Student’s Name)
Pre-College Program for ______at ______.
(years) (site)
Any comments the scholarship committee should consider about this applicant?
______
______
______
______
To the best of my knowledge, the information provided above is true.
Signature ______
Coordinator, NC-MSENPre-College Program
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