UNIVERSITY OF ILLINOIS
College of Engineering
Continuing Student Scholarship/Award Application
Deadline: Friday February 28, 2014
Student Eligibility: Minimum of 30.0 semester hours of completed coursework at the end of the spring semester; 12.0 semester hours must be at UIC with a minimum GPA of 3.00/4.00; continued enrollment in the UIC College of Engineering as a full-time student during the 2014/2015 academic year. (Part-time students are not eligible to apply.)
I. Applicant Information [Please print or type this application.]
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|UIN#_________________________ Major ________________________________________ |
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|Name _________________________________________________________________________________________ |
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|Address _______________________________________________________________________________________ |
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|City ________________________ State _______________ Zip ______________ COUNTY____________________ |
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|Telephone ___________________ UIC email ____________________________ US Citizen/Perm Res____________ |
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|Ethnic background ________________________________________________________ Gender M ____ F _____ |
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|Military Service: Veteran Y ______ N ______ Reserves _______ ROTC __________________ |
|Branch _____________________________________ Parents in Military Y ______ N ______ |
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|High School or Prior College Attended ______________________________________________________________ |
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|Expected Graduation Date (UIC) _____________________ |
II. Awards, Honors & Other Recognition [e.g., Honors College, Tau Beta Pi, Dean’s List, awards, certificates, etc]
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|Awards _______________________________________________________________________________________ |
|______________________________________________________________________________________________ |
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|Honors _______________________________________________________________________________________ |
|______________________________________________________________________________________________ |
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|Other Recognition ______________________________________________________________________________ |
|_____________________________________________________________________________________________ |
III. Parental Employment Information
|Is a parent or guardian a current or past employee of Ameritech, SBC, AT&T, Illinois Bell or Lucent? Yes___ No___ |
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-
IV. Membership & Activities in Engineering Societies [explain your role(s)]
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|_____________________________________________________________________________________________ |
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|_____________________________________________________________________________________________ |
- Continued -
V. Other Activities [explain, e.g., community activities, member of ROTC and/or service in military reserve]
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|_____________________________________________________________________________________________ |
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|_____________________________________________________________________________________________ |
VI. Current Scholarships/Financial Aid [specify type (loan or grant), date and amount of assistance]
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|_____________________________________________________________________________________________ |
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|_____________________________________________________________________________________________ |
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|_____________________________________________________________________________________________ |
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|______________________________________________________________________________________________ |
VII. Post High School Employment Record
|Employer Location Position Dates Full / Part Time |
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|______________________________________________________________________________________________ |
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|______________________________________________________________________________________________ |
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|______________________________________________________________________________________________ |
VIII. Letters of Nomination [list names of two UIC faculty/administrative staff from whom you have requested a Letter of Nomination. Letters of Nomination must be submitted to you in sealed envelopes with your application.]
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|______________________________________________________________________________________________ |
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|______________________________________________________________________________________________ |
IX. Statement of Scholarly and Professional Goals [typed, one page, double-spaced maximum]
X. Permission for Release of Records [application cannot be processed without authorization to release your records]
|Do you authorize disclosure of your academic and financial aid records by the University? * Yes_____ No______ |
|Do you give the College of Engineering permission to release to the donor of any scholarship that you receive, information regarding student and public |
|memberships and activities that are mentioned in this application or recommendation letters? |
|Yes_____ No_____ |
|_____________________________________________________________________________________________ |
|Signature Date |
|* If financial aid information is not supplied, applicants will not be considered for those awards requiring financial need. |
Submit your application packet to the College of Engineering Undergraduate Office, M/C 159, SEO 123;
Attn: Evelyn Esquivel, by Friday, February 28, 2014.
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