Merwin Scholarship
NAME:
DATE:
INTRODUCTION – ABOUT YOU
Full Name:
IEEE Membership Number:
Email Address:
Permanent Mailing Address:
CHAPTER INFORMATION
IEEE Section:
IEEE Student Branch:
IEEE Student Branch Chapter:
Student Branch Chapter Faculty Adviser:
Student Branch/Chapter Chair (Please notate which one):
EDUCATION
Name of Academic Institution:
Address of Academic Institution:
Degree track (Bachelors, Masters, PhD):
Degree/Field of Study:
Expected Graduation Date:
ACADEMICS
GPA (if applicable):
What is the scale (IE. 3.5/4.0):
If your transcript does not have a GPA, what is your average score as a percentage:
(If you need to calculate the percentage, please include a spreadsheet to verify)
%
Merwin Scholarship
NAME:
DATE:
Notes:
IEEE Membership Number
 This can be found on your membership card.
 Alternatively, log in to www.ieee.org then click on your name in the top right hand corner
and select “My Account”, then “Personal Profile”.
IEEE Section & Region Number
 Your Section is written on your membership card, region information can be found here:
http://www.ieee.org/societies_communities/geo_activities/regional_world_map.html
 OR log in to www.ieee.org then click on your name in the top right hand corner and select
“My Account”, then “Membership and Subscription History” and your Section and Region
will be displayed.
Name of Student Branch / Chapter Counsellor or Adviser
 If you have a Student Chapter please list the Chapter or the Student Branch
 If you do not have a Student Branch at your University, write “none”
Name of Student Branch / Chapter Counsellor or Adviser
 Put either a Counsellor or Adviser from the Student Chapter or a Counsellor or Adviser
from the student Branch – select the person you have worked with most closely. This
should be the same person that you receive a letter from as part of the application
process.

If no Student Chapter or Student Branch, select the name of the Chair of the Computer
Society Chapter in your local section and ask them to write the letter for you. If you have been
active in the IEEE as a volunteer, but don’t work with the Computer Society Chapter Chair, you
still need them to write the letter on your behalf. GPA

Many academic transcripts give a GPA (Grade Point Average) as an overall score. Most
GPAs are on a scale out of 4. A few are on a scale out of 5 or 10. Please record the score
and indicate the scale.
Average Score
 If you do not have a GPA your overall score as a percentage will be used.
 Some academic transcripts state this number, if so, just copy it down.
 If the number is not shown, make a spreadsheet listing all your grades, how many points
each subject is worth, and then calculate the average. Please submit your spreadsheet
along with your application if this option is selected.
 If you are a research student without course work, please put “N/A” and include a letter
from your supervisor / university that indicates you are making satisfactory progress.
DECLARATION OF INTENTION TO STUDY
Please select the declaration that applies to you:
I declare that it is my intent to continue studying on a full-time basis for a minimum of 2
consecutive terms to complete my current degree.
Name:
Signature:
Date:
I declare that it is my intent to complete my current degree and then immediately begin a new
course of study. I intend to be a full-time student over the next 2 consecutive terms.
Name:
Signature:
Date:
DECLARATION OF ORIGINAL WORK
I declare that this application with the exception of the academic transcript(s) and the letter of
recommendation is my own original and individual work. I further declare that this application is
fully accurate to the best of my knowledge.
Name:
Signature:
Date:
LEADERSHIP ROLES IN IEEE
List of Roles (and year)


You may add details of your major achievements, challenges you have overcome, or details
related to the above roles. Your aim is to show us how significant a contribution you have made as
a student leader in the IEEE. (Delete this red text before you submit this application!)
ACADEMIC SCHOLARSHIPS OR AWARDS WHILE ENROLLED IN COLLEGE/UNIVERSITY
Your aim in this section is to provide evidence of academic ability beyond what is reflected in your
transcript. If you have not received any academic scholarships or awards you can delete this
section. (Delete this red text before you submit this application!)
NON-IEEE EXTRACURRICULAR ACTIVITIES WHILE IN COLLEGE/UNIVERSITY
List of Roles (and year)


You may add details of your major achievements, challenges you have overcome, or details
related to the above roles. Your aim is to show us how significant a contribution you have made to
the student community, the general community, or other communities your are involved with
outside of IEEE. This is an opportunity both to demonstrate your leadership and to show your
range of interests. (Delete this red text before you submit this application!)
STUDENT AMBASSADOR VISION (LIMIT OF 1 PAGE)
Winners of the Merwin Award become Student Ambassadors for a year. Student Ambassadors are
a leadership position in the Computer Society that allows you to make a difference not only locally
but across your country and region. Use your vision statement to tell us how you will do that.
Specifically you should cover:
-
Your vision to promote the Computer Society to students locally and globally
-
How you will serve as a liaison between the IEEE Computer Society Member and
Geographic Activities Board (MGAB) and student members
-
How you will use this position to: Encourage formation of new chapters; Encourage
more students to join their student branch/chapter; provide relevant interesting, and
useful information, services and activities to student members
(Delete this red text before you submit this application!)
CHECKLIST
☐ Application is 10 pages or less (Excludes letter of recommendation, transcripts, & cover page)
-
For clarity, this means this document once completed should contain: Cover page;
notes page; declarations page; up to 8 pages covering your IEEE involvement, non
IEEE involvement, and any academic awards; vision statement page; check list page.
-
Additionally, in separate documents, or as part of this document, you need to
provide 1 or 2 letters; your transcript and possibly a spreadsheet showing your
average grade as a percentage
-
Please submit the application as a single zip file or as a single pdf by e-mailing it to
e.berkowitz@computer.org
☐ Completed the cover sheet
☐ JPG, PSD, or GIF high resolution photo of myself (solo pictures only) included
☐ Copy of my academic transcript
☐ GPA or academic spreadsheet included
☐ Letter of recommendation from Student Branch/Chapter Counsellor or Adviser (If you have
neither please use the Chair of the Computer Society Chapter in your local section)
☐ Second letter of recommendation (this is optional, if included it can be from anyone)
☐ My application includes (up to 8 pages covering):
-
A list of volunteer leadership roles in IEEE (formal or informal one time IEEE roles)
-
A list of any academic scholarships or awards while enrolled in college/university
-
A list of NON-IEEE extracurricular activities while in college/university
☐ A one page Student Ambassador Vision summary including:
-
Your vision to promote the Computer Society to students locally and globally
-
How you will serve as a liaison between the IEEE Computer Society Member and
Geographic Activities Board (MGAB) and student members
-
How you will use this position to: Encourage formation of new chapters; Encourage
more students to join their student branch/chapter; provide relevant interesting, and
useful information, services and activities to student members
IMPORTANT:
Ultimately your application will be judged on the evaluation criteria. You need to ensure your application
does this. You may add extra section, or include addition details in the sections with notes in red in this
form, in order to better meet the criteria. The criteria, as listed on the website, are:
Evaluation criteria include participation in student IEEE branch/chapter activities (30%), academic
achievement (30%), extracurricular activities (10%), letter of recommendation from student branch/chapter
advisor (20%), and quality of Student Ambassador vision statement (10%).