Application for Schultz-Werth Award
ELECTRONIC SUBMISSIONS DUE TO
sandra.newman@sdstate.edu 5:00 PM MARCH 25, 2016
Name:
Last
First
Middle
Local Address:
Phone Number:
Email Address:
Student ID Number:
Award Division [A or B]
A. Social Sciences, Arts and Humanities
B. Physical and Biological Sciences, Mathematics and Engineering
Academic Major:
Academic Advisor:
Credits earned:________ Semester intending to graduate with bachelor’s degree:____________________
Person advising me in preparation of the
research paper/scholarly or creative project:
Title of Research Paper/Scholarly or Creative Project:
Project Objectives:
Statement of how this research/scholarly or creative project will contribute to knowledge or the
understanding of present knowledge and literature of the field. (Please make sure your statement can be
understood by people outside your own discipline).
I testify that the paper submitted for the award is a result of original, independent scholarly and creative
activity on my part.
Electronic Signature:
Date:
Candidate
ATTEST:
The paper submitted for the award is the result of the student’s original and independent work. It is not a
collaborative effort.
Electronic Signature:
Date:
Advisor/Research Sponsor
Abstract
Abstract of Schultz-Werth Research/Scholarly or Creative Project: (Your 300-word abstract must include
brief statements on your research objectives, rationale, methods, important results or findings, and the
overall significance of your work to society at large.)
Schultz-Werth Award
Applicant’s Biographical Data
Name:
Local Address:
Permanent Address:
Parent Name:
Parent Address:
Major:
Major Advisor:
College:
GPA:
College Honors and Activities:
High School from which you graduated and year of graduation:
Colleges Attended and Dates:
Future Educational Goals:
Future Professional and Career Goals:
Hometown or Local Media (newspaper, radio, television stations, etc.):
Revised Spring 2015