ARKANSAS STATE UNIVERSITY
College of Engineering
P. O. Box 1740
State University, AR 72467-1740
Scholarship Application Form
(Return to College of Engineering by April 1 for consideration for the next academic year)
DATE: ________________ SOCIAL SECURITY # ________________________
NAME: __________________________________________________________
ADDRESS: _______________________________________________________
Street/Box No.
City
State
Zip
Telephone # (
)
Date of Birth _____________________
Which field of engineering/ technology studies do you plan to enter?
___________________
How many college credit hours do you have _____?
Name of Institution ______________________________________, GPA ____.
Have you already registered at ASU for summer or next fall? ________________
If not, when do you plan to register for summer or next year’s classes? ________
What is your most recent composite ACT score? _________________________
Name of individual who supports you __________________________________
Address: _________________________________________________________
Street/Box No.
City
State
Zip
Relationship to you ________________________________________________
Occupation
Employer ________________________
Number of other children in your family who will be in college, secondary or other
school during the next four years, where they will be enrolled and the annual
amount to be contributed by family toward their
education.________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Applicant should attach a short statement, not to exceed 1 page, describing your
interests and why you have chosen engineering/ technology as a career.
Applicant should complete the following "Anticipated Expenses" and "Sources of
Income" portions for financial need to be taken into consideration when the
application is reviewed.
Anticipated Expenses for the coming year.
Tuition
Room & Board
Books & Supplies
Personal Misc.
Other
(Describe)
TOTAL
$________
$________
$________
$________
$________
$________
Sources of Income for the coming year.
Parents
Scholarships
Employment
Work/Study Pgm.
Other
(Describe)
TOTAL
$________
$________
$________
$________
$________
$________
Family's Estimated Gross Annual Income $______________
ACTIVITIES
List your school and community activities (other than jobs) in order of their
interest to you.
Activity
Hours per week
Positions held, special honors, etc.
HONORS
List any special honors you have received, either in or outside of school.
Work Experiences
List part-time and summer jobs you have held since entering high school.
Employer
Duties
Dates of Employment
Hrs per wk
DATE: __________ Signature of Applicant ___________________________
DATE: __________ Signature of Parent or Guardian ___________________
SECONDARY SCHOOL REPORT
(For Incoming Freshmen)
Dear Principal:
The student whose name appears on this application has applied for a
scholarship from the College of Engineering at Arkansas State University. We
believe a student’s record to date is an indicator of future performance,
hence, we will profit from your knowledge of this applicant’s record.
Whatever information you provide will be used only in the process of
screening the scholarship applicants and will be held in complete confidence.
Thank you for your help.
ASU College of Engineering
(*Even though the school year has not ended, we need your best estimate of
where this student will rank percentage wise in his class.)
*RANK IN CLASS _________
Number of seniors in class ___________
Student’s rank percentage wise _________
Grade Point Average (to date) _________
GRADING SYSTEM – Please list your complete grading system, from highest
to lowest:
NOTE: Please attach a copy of your standard transcript, including all test
scores.
Your cooperation in assisting this student, and the engineering profession, is
sincerely appreciated.
Date: ______________
_________________________________________
(Signature of Principal)
Principal’s Name ________________________________________________
High School ___________________________________________________
High School Address _____________________________________________
City _______________ State _____ Zip _______ Telephone #___________
Return completed application to:
College of Engineering
P.O. Box 1740
State University, AR 72467-1740