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Name: ______________________________________________________
Scholarship Application
2015 – 2016 Academic Year
Department of Chemistry & Biochemistry
Applicant: Check all scholarships for which you are eligible or would like to be considered.
 Where it lists “sophomore-senior”, that refers to what you’ll be during the scholarship year.
 Note: For some of the scholarships, more than one may be awarded.
Eligible
Amount
$100
≤5 available
Name
Chemistry Research Scholarship
$200
≤3 available
Chemistry Research Scholarship
1.
2.
3.
4.
≤$500
2 Available
Jerome E. Swanson Chemistry Endowed
Scholarship
≤$1,000
1 Available
Sol Shulman Endowed Scholarship
≤$2,000
≤3 Available
Ben McCashland Endowed Scholarship
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
4.
Description
Chemistry or BCBT Major
Minimum GPA 3.0
Sophomore - Senior
Must be currently enrolled in
research with the expectation of
continuing research in the
scholarship year
Chemistry or BCBT Major
Minimum GPA 3.3
Sophomore - Senior
Must be currently enrolled in
research with the expectation of
continuing research in the
scholarship year
Chemistry or BCBT Major
Minimum GPA 3.5
Sophomore - Senior
Chemistry (not BCBT) Major
Minimum GPA 3.5
Junior – Senior
Chemistry or BCBT Major
Minimum GPA 3.6
Senior
Biographical Questionnaire
I affirm the information contained herein is true and accurate to the best of my knowledge and belief.
Signature ________________________________________________________ Date ___________
Dragon ID: __________________
A. You, the Nominee
Legal name in full _____________________________________________________________________
(Print/Type)
Last
First
MI
E-mail Address_________________________________________
Telephone _____________________
Campus Address _______________________________________________________________________
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Permanent Address ____________________________________________________________________
In which category will you be in the 2015 – 2016 academic year? (You can use either the “by credits” definition, or
simply the “sophomore = second year in college” sort of definition.)
_______ Sophomore
_______ Junior
_______ Senior
What chemistry courses did you take this year _______________________________________
What chemistry courses will you take next year?_________________________________________
Which semester do you expect to graduate? __________________________________
B. Your Education
What is your undergraduate major(s)?
(Include Emphasis)
____________________________________________
____________________________________________
Any minor(s) or second majors
____________________________________________
____________________________________________
What will be your tentative area/field of specialization after graduation? _________________________
_____________________________________________________________________________________
Attach unofficial transcripts (from all undergraduate schools attended)._________________________
What is your MSUM GPA and # of credits? MSUM GPA: _____________Credits:___________________
List other schools, GPA’s, and credits from which you have earned more than 6 college credits
School:______________________________GPA: ________Credits:_______When:___________
School:______________________________GPA: ________Credits:_______ When:___________
Application Information:
1.
Answer each of the questions on the following page in paragraph form.
2.
Applications are due Wednesday March 25, 2015 by 12:00 noon. (The Wednesday after Spring Break).
 Applications should be Emailed in PDF form to BOTH administrative assistant Melissa Dubord
dubordme@mnstate.edu AND to scholarship chair Craig Jasperse (jasperse@mnstate.edu). When
emailed, include “Chemistry Scholarship Application” and your name in the Subject line of the email.
3.
Applicants for senior scholarships (Ben McCashland Endowed Scholarship) must include a resume. Including a
resume is welcome but not required for the other scholarships.
3
Answer each of the following questions in paragraph form.


Limit each answer to 250 words or less per question.
Answers must be typed.
1. List any awards, honors, or scholarships you have received.
2. Describe your career goals.
3. Describe your participation in research and any accomplishments in this area.
4. Describe any significant involvement(s) in campus activities or organizations.