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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