Robert Noyce WITS Scholarship Application
Wyoming Interns to Teacher Scholars (NOYCE)
Eligibility Requirements and Federal Guidelines
1. For every year the recipient completes teaching in an eligible school district, they will be required to have the principal of the school write an official letter on school letterhead to confirm employment.
2. Service must be performed within eight years after graduation from the program for which the stipend was awarded.
3. All WITS scholars must sign an agreement with respect to their service requirements as stipulated by the National Science Foundation.
4. The WITS scholarship will be dispersed in three payments for each year (fall, spring, summer) the scholar is enrolled in the program.
5. The Science and Mathematics Teaching Center at the University of Wyoming along with the Sponsored Research Office at Central Wyoming College will coordinate the distribution of the scholarships and collection of funds from students who fail to meet the terms of the agreement.
6. In cases where students must repay the scholarship, the SMTC will be responsible for collecting repayment in accordance with PL 107-368, SEC 10. If the recipient leaves school, or drops below half-time enrollment, he/she will have a six-month grace period before repayment begins. During this period, scholars will receive payment information and be notified of the payment due date. They are responsible for making payments on time.
7. If a student defaults on repayment, UW/CWC will place a hold on the student’s account; no transcripts can be obtained, and the student will be denied University services.
8. UW/CWC will pursue legal channels through University counsel to collect the unpaid balance. Documented verification of extreme hardship or other circumstances to cancel repayment of scholars may be given consideration according to University guidelines on extreme hardship.
Scholarship Application
Wyoming Interns to Teacher Scholars (NOYCE)
2017 Summer Session ² 2017-2018 Academic Year
Please print or type. APPLICATION DEADLINE: April 1, 2017
1. Name ______2. W ______
last first middle UW Student ID number
3. Permanent address______4. Phone No. ______
5. ______6. Email ______
city state zip
7. For which terms are you applying for a scholarship (check all that apply)? ¨ Summer 2017 ¨ Fall 2017 ¨ Spring 2018
8. Academic status Summer 2017: ¨ Graduate/Professional School ¨ Senior ¨ Junior ¨ Certification student
Fall 2017: ¨ Graduate/Professional School ¨ Senior ¨ Junior ¨ Certification student
Spring 2018: ¨ Graduate/Professional School ¨ Senior ¨ Junior ¨ Certification student
If available, please provide a copy of your letter of admission/acceptance, if beginning a new program at UW for Summer 2017 or Academic Year 2017-18.
9. If you will enroll for UW credit in off-campus study for Summer 2017 and/or Academic Year 2017-18, indicate dates ______to ______.
Which program? ______Location: ______
(for example: Outreach or on-line classes, UW/CC Center, student teaching, student exchange, clinical training, practicums, etc.)
Will you also enroll for credit on campus in Laramie at the same time? ¨ yes ¨ no How many off-campus credits will you take? ______
10. Degree sought ______
11. Proposed course of study (major) ______
12. Indicate the number of full-time semesters you estimate will be necessary for you to complete your degree. ______semesters
13. Current status (check all that apply): ¨ now attending UW ¨ Current WITS scholarship recipient ¨ former WITS scholarship recipient
14. List all colleges you have previously attended, with dates of attendance and degrees received. If you have not previously done so, please provide the Committee
with an unofficial transcript of all college course work attempted.
Institution City/State Dates attended Degree(s) received
______
______
______
15. Please list the legal dependents under age 18 other than your spouse whom you will be supporting while you are on scholarship? ______dependents
FULL NAME RELATIONSHIP TO YOU AGE
______
______
______
______
Modified September 2016
WYOMING INTERNS TO TEACHER SCHOLARS (NOYCE) SCHOLARSHIP APPLICATION - Page 2
16. Gender: ¨ Male ¨ Female
17. Birth date: ______Age ______
18. Race/Ethnicity: ______
19. Are you a veteran of the U.S. armed forces or a member of the National Guard? ¨ yes ¨ no Are you receiving VA educational benefits? ¨ yes ¨ no
If yes, please provide the Committee with a copy of your discharge papers.
20. Have you taken the appropriate undergraduate qualifying exam (SAT, ACT)? ¨ yes ¨ no
If yes, which test? ______When? ______What were your scores? ______
21. Have you been a resident of Wyoming for at least the past calendar year? ¨ yes ¨ no
22. Please list other Summer 2017 and Academic Year 2017-18 scholarships that you have applied for or received.
______
______
______
23. Please explain in a 500-word essay why you want to become a STEM elementary teacher, why you selected your academic major, how you plan to use your education after graduation, and what benefit you think your efforts will be to the STEM education community. Please use a separate sheet of paper.
CERTIFICATION: By signing below, I certify that I have read and understand the rules governing the selection process and my obligations for retention of this scholarship. The information I have provided is true and accurate to the best of my knowledge. I give my consent to have my application, my transcripts, my test scores, and/or my financial information released to the members of the Committee. I also give my consent for my name and information in this application to be released as a recipient, if awarded this scholarship.
______
Applicant's signature Date signed
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SCHOLARSHIP APPLICATION CHECKLIST
¨ Completed application
¨ UW letter of Admission (for undergraduate students)*
¨ Documentation of courses required to retain present position
(for certification students)*
¨ College entrance exam scores (undergraduate students)*
¨ Official academic transcript for each college attended*
¨ Military discharge papers (Form DD-214) if a veteran*
* = if these items were presented with a prior year's application, upon request, they will be attached to this application.
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Return application and attachments by April 1, 2017, to Jacqueline Leonard, 1000 E. University Ave., Department 3374, Laramie, WY 82071.
WITS-APP 17