HOUSTON GEOLOGICAL SOCIETY
WARREN L. AND FLORENCE W. CALVERT
MEMORIAL SCHOLARSHIP FUND
14811 St. Mary’s, Suite 250
Houston, Texas 77079
(713) 463-9476
(281) 679-5504 FAX
APPLICATION FOR A GRADUATE SCHOLARSHIP AWARD
Name:___________________________
Marital Status:______________
_
Date of Birth:______________
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Student Classification (Sr., Grad.):__________
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Current Address:___________________________________________________
Permanent Address:_________________________________________________
Tel. No. _____________
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E-mail ______________________
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College or university you presently attend:________________________________
Area of specialization in the earth sciences:_______________________________
Degree Objective (MS/PhD)____
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Expected date of completion____
_________
Name and address of academic department to which you have been unconditionally admitted for graduate
study:
YOU MUST ANSWER YES TO THE FOLLOWING QUESTIONS TO BE ELIGIBLE:
1. I am a citizen of the United States of America.
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2. I have never been convicted of a felony or other major crime.
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3. I have not, and will not refuse to serve in the armed forces of the
United States of America.
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4. I affirm and support the Constitution of the United States of America.
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5. I plan a career in petroleum geology, mining geology, exploration geophysics,
or another branch of economic or environmental geology.
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6. If chosen for a scholarship award, I agree to carry at least 9 credit hours/quarter
or semester (excluding summers) during my tenure as a graduate scholar.
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The Scholarship Board would like to insure that awards go to students who truly need
financial support. Please assist us in this determination by stating the extent to which your
personal income from all sources fails to meet your educational costs and living expenses. Also,
list all scholarships and their amounts that you will receive during the forthcoming academic
year.
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Attach grade transcripts from all colleges and universities you have attended. Please discuss your
grades if you feel they do not properly represent your past or potential academic performance.
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Please request letters of reference to be sent directly to us (see item 5 below) from three persons not
related to you who will attest to your character. At least one person must be one of your instructors or
academic advisors during your last year of study. List the names and addresses of these persons:
l.
2.
3.
NOTES
1. Please enclose a brief summary of your:
a) past and present employment
b) activities and interests
c) experience in positions of leadership and service.
2. Scholarship awards will be announced no later than July 15. All applicants will be notified of the
status of their application by July 3l.
3. Annual renewal of scholarships will be considered provided the recipient continues to make
satisfactory progress toward his/her degree objective.
4. In order to increase its ability to offer scholarships to larger numbers of students, the Board requests
that each recipient consider returning a portion of the scholarship award to the fund within 10 years of
his/her graduation.
5. Completed application forms and supporting documents must be mailed before June l to:
Dr. Alison Henning
Department of Earth Science
Rice University
6100 Main Street
Houston, Texas 77005
I hereby affirm that the foregoing statements are
true and correct to the best of my knowledge
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Applicant's Signature