2016 UNDERGRADUATE SCHOLARSHIP / AWARD APPLICATION
Application packets with printed copies of all materials must be submitted to the Psychology Department
Main Office by Monday, February 22 at 5:00pm. Please address packets to Michelle “Lani” Shiota, Chair of
Awards Committee. Due to confidentiality concerns, applications are NOT accepted by email. Recipients
will be informed of their awards in March 2016. Financial awards will be disbursed in Fall 2016; you MUST
be enrolled full-time in Fall 2016 to be eligible for these awards.
THIS APPLICATION IS FOR PSYCHOLOGY SCHOLARSHIPS ONLY.
By completing and submitting this form by the deadline, you automatically apply for all undergraduate Department
of Psychology scholarships. To see a complete list of these scholarships, please refer to the department web
page, http://psychology.clas.asu.edu/undergrad/scholarships
I. GENERAL INFORMATION:
NAME:
(Last)
(First)
(Middle)
ASU ID #
WHAT HIGH SCHOOL DID YOU ATTEND? (INCLUDE CITY AND STATE)
CURRENT STREET ADDRESS
CITY
PHONE #
EMAIL ADDRESS
(
)
STATE
ZIP CODE
-
MAJOR 1
MAJOR 2 (if applicable)
CLASS LEVEL (For the CURRENT Academic Year, 2015-16)
ANTICIPATED # OF CREDIT HOURS TO BE ENROLLED
□Freshman □Sophomore □Junior □Senior
Fall 2016
ASU Cumulative GPA ______
Transfer GPA _______
Psychology GPA _______
TOTAL CREDIT HRS EARNED TO DATE
Spring 2017
ANTICIPATED GRADUATION DATE (Month/Year)
II. SCHOLARSHIP ELIGIBILITY INFORMATION: (These questions establish eligibility for specific scholarships. You are not required to answer
every question, but missing answers will affect your consideration for some awards.)
1. Are you currently enrolled as a full time student at ASU?
2. Have you completed the FAFSA and applied for financial aid through ASU for 2016-17?
3. Are you a United States citizen?
3. Are you a “returning” student? A returning student is a student who has previously attended a community
college, college, or university, left school for a time period, and has now returned to complete a degree. If
yes, please explain in Essay #1.
4. Do you work at a paying job? If yes, how many hours do you work each week? ____________
5. Have any of your research activities directly involved biosychology? If yes, please describe in Essay #1.
6. Have any of your research activities involved non-laboratory settings, and/or directly addressed
significant social problems through empirical science? If yes, please describe in Essay #1.
7. Do your studies focus on preparing you for a career serving young children and their families?
If yes, please discuss these activities and goals in Essay #1.
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
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III. ESSAY QUESTIONS: Please complete each essay in this section on a separate document in Word format, using 12-point Times
New Roman font, double-spacing, and 1-inch margins; 1 page maximum per essay. If the particular scholarship(s) for which you
are applying require(s) certain accomplishments, specific background information, or specific academic/career goals, these should be
reflected in your essays.
ESSAY #1 - REQUIRED
Academic Accomplishments and Career Goals: Describe your academic accomplishments, including undergraduate research
involvement, internship experience, and honors thesis (if applicable). Describe your future educational and career goals.
ESSAY #2 - REQUIRED
Community Involvement and Leadership Activities: Describe your involvement in community involvement/service activities,
including duration (e.g., number of years), hours per week or month, specific activities/responsibilities, and any leadership roles. If
your service activities have helped you to prepare for the career goals described in Essay #1, please explain that here.
ESSAY #3 - OPTIONAL
Background: Some scholarships/awards give preference to students who have faced personal or economic challenges. If you
wish to be considered for these awards, please complete this essay describing these challenges and how you have worked to
overcome them.
IV. SUPPORTING DOCUMENTS: Please include a copy of your unofficial transcript. You may also include a resume/CV, and any
other relevant supporting material.
V. FACULTY SUPPORT. Provide the name of the Psychology Department faculty member who is in the best position to judge the
quality of your work (coursework, research activities, honors thesis, etc.) and to support your scholarship application.
Faculty Member
Capacity (e.g., Courses Taken with Faculty, Research, Thesis, etc.)
Date/Semester
VI. CERTIFICATION. The signature below indicates that the information on this application is true and accurate to the best of my
knowledge, and that I give my consent for ASU to release academic, financial and/or other information to the Department of
Psychology for the purpose of selecting awardees.
SIGNATURE: ______________________________________________________DATE:________________________
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