Directions: The UW-STOUT NSF-STEM STARS Scholarship program will provide a scholarship of up to $5,000 for one year to Applied
Science (biotechnology and nanotechnology & material science students) and Environmental Science students. Applications can be
submitted immediately. There is a rolling deadline.
TO BE COMPLETED BY APPLICANT FOR NSF S-STEM SCHOLARSHIP
• This scholarship application form
• A 500 word essay describing how receiving this scholarship will enhance your education.
• One letter of recommendation strongly supporting your application for the scholarship
• Transcripts of all college work (can be unofficial)
• A completed and submitted Free Application for Federal Student Aid (FAFSA); use the most recent tax return
FAFSA weblink: http://www.uwstout.edu/ub/scholarships.cfm
• The application form, essay, letters of recommendation, and unofficial transcripts can be sent electronically
to jamesk@uwstout.edu
Last Name: _________________________ First Name: _________________________ MI: _____
Stout Student ID number: _________________________
Street Address: ____________________________________________ Apartment Number: _______
City: _______________________________________ State: ___________ Zip: __________________
Phone: (_______) _______-_____________ Date of Birth (mm/dd/yyyy): ______________________
E-mail address: _______________________________________________
Citizenship category (Please check one):
o U.S. Citizen
o National
o Refugee Alien
o
o
Permanent Resident Alien
None of These
Race/Ethnicity. (Please check all that apply)
o African American or Black
o American Indian (Specify Tribal Affiliation)
o Hawaiian/Pacific Islander
o Hmong
o Other Asian
o
o
o
o
Mexican, Mexican American, Or Chicano/a
Other Hispanic Latino/a
White or Caucasian
Other. Please specify
Which best describes your mother's/female guardian's highest level of education?
o High School diploma or less
o Completed a Bachelor’s degree
o Some college
o Completed a Graduate or Professional degree
o Completed an Associate’s degree
Which best describes your father's/male guardian's highest level of education?
o High School diploma or less
o Completed a Bachelor’s degree
o Some college
o Completed a Graduate or Professional degree
o Completed an Associate’s degree
Have you ever attended a college or university before? _________
If yes, where and when? ______________________________________________________________
Current overall GPA: ________________________________
Which program are you enrolled in?
o Environmental Science
o Applied Science
What do you hope to do after graduating from UW-Stout (career)?
List any rewards or honors you have received:
Briefly describe the research or other extracurricular activities you’ve participated in that have supported your
Environmental Science or Applied Science Education:
I hereby verify that all the information that I have provided is accurate. Your signature gives permission for the,
NSF S-STEM STARS Scholarship Committee to review any academic records and any information pertaining to
your eligibility for Federal Financial Aid.
NAME: _____________________________________________________________________________
SIGNATURE: _________________________________________ DATE: _______________________
Return completed application to:
NSF S-STEM Stars Scholarship Committee
Attn: Krista James
327 Jarvis Hall Science Wing
UW-Stout
Menomonie, WI 54751
jamesk@uwstout.edu