2016-17MinorityScholarship forCollegeStudentsApplication Worksheet

IMPORTANTNOTE:Thisdocumentisforyourownpersonaluseforpracticein preparingyour ScholarshipApplication.The actualnominationformmustbesubmittedonlineat requiredsupportingdocuments.Sincetheonlineapplicationcanonlybesubmittedonce, itis stronglyrecommendedthatyouusethisworksheetto answertheapplicationquestionsfirst, then you cansimplytransferyour answerstotheonline application whenyouarereadyto submit.This worksheetwillnot beacceptedin placeof theonline application.Allapplications mustbereceivednolater thanJuly1,2016.If you haveanyquestions,pleasee-mail

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Rules,Criteria,and SubmissionRequirements

1. Previousrecipientsof this scholarshipareeligibletoreapply.

2. Applicantsshall berequiredtobeundergraduatesinchemical engineeringduringthe2016-2017 academicyear andbemembersof aminoritygroupthat isunder-represented inchemical engineering, i.e., African-American,Hispanic, NativeAmerican,AlaskanNative, PacificIslander. Applicantswhowillcomplete thechemicalengineeringbaccalaureatedegreerequirementsin mid-academicyear(i.e., after onesemesterofone or twoquarters),if successful,willreceive proratedawards. Candidateswhoreceivethe scholarship areexpected tojointheir college’s AIChEStudent Chapter.

3. Selectionof winnerswill bebased onthefollowingcriteria:

i.Theapplicant’sacademicrecord,minimumGPA of3.0/4.0.

ii. Theapplicant’sparticipation in AIChEstudentchapter,andprofessionalor civicactivitiesas outlined inthechapteradvisor’s, departmentchair’s,orother faculty member’sevaluation in his/herletterofnomination.

iii.Applicant’scareerobjectivesandplans asoutlinedinhis/her careeressay.

4. Theapplicant’sfinancial need asoutlined intheEFC(ExpectedFamilyContribution)

5. Individual awards for thefull academicyearwillbe$1,000. Awardswillbeannounced by September/October2016andpayment disbursedtoeach winneruponreceiptof acopyof the proofof 2016fall-semestercollegeregistration, as well as their tax information (social security number required for U.S. residents).Noawardwill besentafterDecember31, 2016.

6. Inadditionto thisaward, TheOutstandingScholasticAchievement Awardthatconsistsof a plaqueand$1,500honorariummaybeawardedtoeligible applicants. Noseparateapplication formisrequired forthat award.

Instructionsforsubmittinganapplication:

A completeapplicationforthe 2016-17AIChEMinorityScholarshipAwardwillcontainacopyof eachof the followingitems (each lettershouldcontainanoriginal signaturetobescanned anduploaded).

1. A completed applicationformsubmitted online.

2. A careeressaynottoexceed300wordsoutliningimmediateplans after graduation, areasof chemical engineeringinterest, andlong-rangecareerobjectives

3. A résumé (CV-Curriculum Vitae)

4. Unofficial copyofstudent transcript

5. AnEFC (ExpectedFamilyContribution)provided by CollegeBoard or from The Free Application for Federal Student Aid, FAFSA

(Optional:A letterfromthe parent/guardian verifyingfinancial needcanalsobeincluded with theEFC.Pleaseincludea list of financial resourcesfor educational support.)

6. A letterof recommendationfrom theAIChEstudentchapter advisor, departmentchair,or chemical engineeringfacultymembercontaining, but notlimitedto, thefollowing:

i.Verification ofnominee’sGPA and projected completiondate.

ii. Anevaluationof thestudent’sacademicperformanceand participation in AIChEand other

professionalor civic activities.

iii.Confirmationofminoritygroupofstudent.

APPLICATION

RENEWAL ( YES/NO) :

FirstName LastName

StreetAddress

Address Line2

City

State/Province/Region

Postal/ZipCode

Country

Cell Phone#

Home Phone#

Email

University/College Attending

Expected dateofcompletionoftherequirementsforthe BaccalaureateDegreeinChemical Engineering

*_/ /MM DD YY

CumulativeGPA

Maximum PossibleGPA

SelectMinorityGroup:

□African-American

□Alaskan Native

□Hispanic

□NativeAmerican

□PacificIslander

□Other

If Other , Specify :

SelectGender:

□Male

□Female

□I prefernottodisclose

FILEUPLOAD CHECKLIST

When yousubmityourapplicationonline,youwill needthefollowingdocumentstouploadwithyour form.

_CareerEssay

Resume (CV-Curriculum Vitae)

_EFC (ExpectedFamilyContributionLetter) provided by College Board or from FAFSA

_Unofficial Transcript

_RecommendationLetter

Parent/GuardianLetterVerifyingFinancial Need (Optional)