2016-2017 Honors Scholarship
Application Form
Please submit one (1) hard copy of this application to the Honors Program Office.
Biographical Profile:
Name: First __________________ Last ____________________ MI _____
Sac State I.D. # __________ Gender: [
] Male
[ ] Female
Address ________________________________________
City __________________________________________
Daytime Phone: (
) _____________________
Date of Birth: ______________
Phone: (
) ________
State _________
Zip Code _______________
Email_________________________________________
Mailing Address (if different) __________________________________________________________________
City ___________________________________________ State __________
Zip Code ________________
Daytime Phone _____________________________ Ethnic identity (optional) ________________________
Applicant Certification:
I read and understood the criteria to be eligible for an Honors Program Scholarship and I wish to be considered.
I have read all the information regarding each Honors Scholarship of interest, met all stated conditions of eligibility,
and, if selected, agree to abide by the regulations stated therein. If selected as an Honors Scholarship awardee, I
give the Honors Program Office and the Sacramento State Scholarship Office permission to release my name,
program or college for promotional purposes.
I hereby certify that the information provided in this application is, to the best of my knowledge, true and correct. I
have not knowingly withheld any facts or circumstances that could otherwise jeopardize consideration of this
application.
X ______________________________________________
___________________
Type Name
Date
(Typing in your name will serve as your signature.)
Please indicate which scholarships you are applying for. Check the attached criteria for eligibility.
[ ]
Edward D. Ermet Scholarship
[ ]
Robert S. Guardino Scholarship
[ ]
Ose Family Honors Scholarship
[ ]
Stremple Math/Science Scholarship
[ ]
Lora L. Dumont Scholarship
[ ] Roberto and Gail Pomo Scholarship
Part I. Please answer the following three questions (all applicants):
1) What contributions have you made to the Honor’s Program at Sacramento State? Or, if you are a first-year
student, what contributions have you made to your high school or your local community? (250 word minimum)
2) As an Honors student, how would this scholarship allow you to pursue your academic or professional goals?
(Please explain in a minimum of 500 words)
3) What changes have occurred in your academic experience since your participation as an Honors Student in the
Sacramento State Honors Program? (Please explain in a minimum of 500 words. Incoming First-Year students
need not answer this question.)
For specific applications, please answer the additional questions below:

For Ose applicants only:
o What are your professional goals following graduation? (Please explain in a minimum of 500 words)

For Stremple applicants only:
o a) What are your future aspirations in the field of math or science? What or who has led you to these
aspirations? (Please explain in a minimum of 500 words)
o b) Your Career Path – How will you benefit in the study of math or science? In other words, how is
your study of math and science a part of your professional career or professional development?
(Please explain in a minimum of 500 words)
Part II. Please provide the following information and documentation as an attachment to your
application.
1. List any honors or special awards that you have received. Do not abbreviate organization names. Begin
with the most recent. Please submit verification of all awards. Scanned or digital documents are preferred.
Award/Honor
date (month/year)
Institution/Organization
 Award in Community Service
December 2010
Associated Students, Inc.
 Academic Award
August 2011
Gates Millennium Scholarship
2. To verify courses taken in college, please provide unofficial copies of all college transcripts (hard copies
please).
3.
Two letters of recommendation delivered to the Honors Program office is required for a complete
submission. The mailing address is 6000 J Street, Sacramento, CA, 95826-6135. We suggest a letter of
recommendations from the following:
A) CSUS faculty (preferred) or Honors faculty
B) Employer or supervisor