Northern New Mexico Engineering and Science Scholarship [PDF]

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Northern New Mexico area high school seniors who plan to major in ... at a four (4) year college or university may apply for this scholarship (due to the ... Page 2 ... Please list the colleges/universities/trade schools to which you have applied:.
ENGINEERING & SCIENCE SCHOLARSHIP 2017 – 2018 This scholarship is sponsored by National Security Technologies, LLC (NSTec), the management and operating contractor for the Nevada National Security Site and its related facilities. NSTec is dedicated to devising integrated solutions and forging new partnerships at the Nevada National Security Site and its related facilities and laboratories for the Department of Energy, National Nuclear Security Administration, Nevada Field Office. As a partner in education, NSTec supports diverse and sustainable education programs focused on improving science, technology, engineering, and math. Learn more about us at www.NSTec.com. Who May Apply Northern New Mexico area high school seniors who plan to major in engineering or science at a four (4) year college or university may apply for this scholarship (due to the wide availability of scholarships for health sciences, those degree programs will not be eligible). A minimum 3.5 cumulative GPA is required. Award Up to two scholarships in the amount of $5,000 each will be awarded. Scholarship funds will be paid directly to the college or university in one disbursement. Deadline Applications must be postmarked no later than Saturday, April 8, 2017. Submit the completed application package in the following order • Applicant’s General Information, Financial Statement, and Certifications and Authorizations forms. • Essay – [“Tell us why you want to pursue a degree in engineering or science?”] The length of your typed essay should be 400-500 words. • Transcript (including 7th semester grades)/Test Scores. • Three (3) letters of recommendation are required. Two must be from a teacher or counselor and one must be from an employer. In the absence of an employer, please provide a third letter from an additional educator, scout leader or other community leader. • The Scholarship Selection Committee may schedule an interview with applicants prior to selection.

SEND COMPLETED APPLICATION PACKAGE TO: Attn: Holly Cox National Security Technologies, LLC PO Box 98521, M/S NLV031 Las Vegas, NV 89193-8521 Or email to: [email protected] 1

ENGINEERING & SCIENCE SCHOLARSHIP 2017 – 2018 APPLICANT’S GENERAL INFORMATION (PLEASE PRINT OR TYPE) I have not taken the SAT or ACT because

Student #: Class Rank: SAT Verbal:

Out of

it is not required for my admission I am taking it at a later date

Weighted GPA:

SAT Math:

Unweighted GPA:

SAT Writing:

ACT Composite:

Please print or type clearly Name of Applicant Last

SS#

First

Date of Birth

M.I.

Place of Birth

Applicant’s Address City

State

Home Phone

Zip Code Work Phone

High school currently enrolled in Email Address (print clearly) Do you intend to work while attending college? Yes

No

Do you work now? Yes

What family responsibilities do you now have?

What are your career goals:

Please list the colleges/universities/trade schools to which you have applied: UNIVERSITY/COLLEGE NAME

Major

Signature of Applicant

Minor

Date

2

No

ENGINEERING & SCIENCE SCHOLARSHIP 2017 – 2018 FINANCIAL STATEMENT Applicant Name of Parent or Guardian(s) (Include mother’s maiden name)

Is this a single parent family?

Yes

No

Occupation of Parent(s) or Guardian(s) Employer

Annual Salary $

Employer

Annual Salary $

Other Income Sources (Include additional scholarships/grants awarded) Source

Amount

Source

Amount

Total income as reported on parent’s federal income tax return $ Total number of exemptions claimed on tax return Number of adults in the family Number of dependent children in the family Number of dependent children who will attend college in the fall If both parents reside at the same address, do they both work?

Yes

No

Estimated annual college costs (tuition, room and board, etc.) $ Are there any additional household or financial circumstances that may pertain to this application? (An additional page may be added if necessary)

Parent/Guardian Signature

Date

Applicant Signature

Date

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ENGINEERING & SCIENCE SCHOLARSHIP 2017 – 2018 CERTIFICATIONS AND AUTHORIZATIONS All of the information provided on this form is true and complete to the best of my knowledge. I certify that I am a senior in high school enrolled in or applying for enrollment at an accredited post-secondary institution for the 2017–2018 academic year. I hereby authorize the NSTec Engineering & Science Scholarship to utilize information about my application and my likeness for publicity and public relations purposes.

Student Signature

Date

Parent/Guardian Signature

Date

(Required if applicant is under 18 years of age)

I understand that if I do not graduate from high school by meeting all standards set forth by the Livermore Valley School District that I will forfeit this scholarship should it be awarded to me. I also agree that all parts of the application are retained as property of NSTec.

Student Signature

Date

Parent/Guardian Signature

Date

(Required if applicant is under 18 years of age)

AUTHORIZATION FOR RELEASE OF RECORDS To comply with the provisions of the Family Educational Rights and Privacy Act of 1974, permission is hereby given to school officials to release the school records and other requested information for consideration in the NSTec Engineering & Science Scholarship.

Student Signature

Date

Parent/Guardian Signature

Date

(Required if applicant is under 18 years of age)

Your application will not be reviewed without this document.

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ENGINEERING & SCIENCE SCHOLARSHIP 2017 – 2018 SCHOLARSHIP SUBMISSION INSTRUCTIONS Use a paperclip to hold your application(s) together and mail in one (1) flat envelope (do not fold or staple any part of your application). Additional documents such as transcripts and letters of recommendation must be included with the rest of your application and not sealed in separate envelopes. Unofficial-unsealed transcripts and letters of recommendation are acceptable. Documents must be submitted in the same order as listed on page one (1) of the application. Folders, report covers, etc. used to submit your application will be discarded. All documents submitted should be printed on single-sided, standard (8 ½” X 11”) paper. If emailing please submit in PDF format.

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