BROOKHAVEN COLLEGE
T-STEM CHALLENGE SCHOLARSHIP APPLICATION FORM
Purpose
The Texas Science, Technology, Engineering, and Mathematics (T-STEM) Challenge Scholarship Program
at Brookhaven College, DCCCD, provides funding for high-achieving, eligible students pursuing a degree
in the STEM field disciplines of biology, chemistry, geology, physics, math, engineering, computer
science, or radiologic sciences.
Benefits
Students selected as T-STEM scholars will receive an opportunity to intern and explore careers and
network with other STEM students, faculty, and industry professionals.
Students will be eligible for merit-based awards of up to $2,500 total over the academic year based on
eligibility and participation criteria.
Requirements
 Register with the Selective Service System or have a statement declaring exemption from
Selective Service. http://www.sss.gov/default.htm

Graduated from high school with a least a 3.0 GPA on a four-point scale in mathematics and
sciences courses

Maintain a program of study with Brookhaven College in an approved STEM field listed above

Complete 30 credit hours for fall, spring, and summer and must be a full-time Brookhaven
College student enrolled in at least 12 credit hours per long semester (Fall and Spring).

Agree to participate by volunteering or interning in a STEM field or related area
Application Process
1. Complete the T-STEM application, T-STEM application questionnaire, and T-STEM scholar profile and
commitment agreement.
2. Provide an official, high school transcript and college transcript (if college hours have been earned).
3. E-mail, mail or deliver completed application packet including transcripts to the following office:
BROOKHAVEN COLLEGE
Development Office
Attn: Ngoc Truong
3939 Valley View Lane
Farmers Branch, TX 75244
972-860-4182, ngoctruong@dcccd.edu
Decisions of the selection committee are final.
The T-STEM Challenge Scholarship Program is funded by a grant from the Texas Higher Education Coordinating Board.
T-STEM Challenge Scholarship Application Instructions
1. Please complete only the shaded areas of all sections. The non-shaded areas cannot
be edited. When completed, please sign, initial where requested, date and submit to
the office identified on page 1 of this packet.
Applicant Information
Applicant First Name:
Last Name:
DCCCD Student ID#:
Date of Birth:
Home Address:
City:
State:
Primary Phone:
Zip:
Secondary Phone:
Primary E-mail Address*:
*The “Primary E-mail Address” you provide here will be used as a central source of communications with
Brookhaven College. You agree to check your primary e-mail to review any messages from the T-STEM
program. You also agree to notify Brookhaven College immediately of any changes in your “Primary Email Address.”
Academic Information
Intended major: Chemistry
College credit hours earned to date:
High school GPA on a four-point scale in mathematics and sciences courses:
Have you registered with the Selective Services System? Yes
Do you plan to complete a minimum of 30 semester credit hours within a year (fall,
spring, and summer semesters or equivalent)? Yes
Have you been a STEM scholar before? Yes
If so, list year and semesters:
Do you intend to graduate from Brookhaven or transfer before earning your degree?
Please choose one answer:
I plan to graduate from Brookhaven College
I plan to transfer before I earn an Associate Degree
Your answer is used for informational purposes and will not impact the decision of the selection committee
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Authorization Information
_______
(Initial)
I release to the Dallas County Community College District (DCCCD) and Brookhaven College TSTEM Challenge Scholarship program the right to access all my current and ongoing personal
and academic records and transcripts. If awarded a scholarship, I understand that I must meet
the award criteria and standards of academic progress for the DCCCD and the Brookhaven
College T-STEM Challenge Scholarship program.
_______
(Initial)
I understand my name and information from my academic history may be released to the
selection committee and the award donor. If granted an award, I release to the DCCCD and
Brookhaven College T-STEM Challenge Scholarship program the right to use my name, story,
and picture for printed and video materials, reports, and press releases, without compensation,
as well as related recognition ceremonies and receptions.
I certify that the statements herein are true to the best of my knowledge and grant my
permission for the information contained herein to be shared with the selection committee
and award donor.
Student Signature:__________________
Date: _________________
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T-STEM CHALLENGE SCHOLARSHIP
APPLICATION QUESTIONNAIRE
Please limit each of your answers to 250 words.
1. What are your STEM career goals?
2. Describe the reasons for your interest in a STEM field.
3. What do you hope to accomplish as a professional in a STEM field?
4. What would be most valuable to you as a STEM scholar and why?
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T-STEM CHALLENGE SCHOLARSHIP PROFILE AND
COMMITMENT AGREEMENT
T-STEM CHALLENGE SCHOLARSHIP PROFILE INFORMATION
(Please enter your information in the shaded areas only.)
Name:
Student ID#:
Phone Number(s):
Primary E-mail Address:
Declared STEM field: Chemistry
Will you be employed during the academic year? Yes If yes: Full-time
Are you receiving financial aid or any additional awards during the academic year? Yes
If yes, please list here (examples: Pell, Rising Star, etc.):
T-STEM SCHOLAR COMMITMENT AGREEMENT
Please review the requirements of the T-STEM program listed below. Then, initial next to each
item as an acknowledgment of your commitment to satisfy each requirement. Failure to meet
these requirements will result in a reduction or loss of award.
_____ I will maintain a program of study with Brookhaven College in an approved STEM field.
_____ I have a 3.0 GPA or higher on a four-point scale in high school mathematics and science
courses, and I agree to maintain a cumulative 3.0 GPA or higher throughout the academic year.
_____ I plan to complete a minimum of 30 credit hours within a year (fall, spring, summer
semesters or equivalent).
_____ I understand that failure to meet these requirements will result in a reduction or loss of
my award.
_____ I understand that, if I am awarded the T-STEM scholarship, it may affect other financial
aid awards I receive. For example, my student loans and/or work study may have to be
reduced. Depending on my financial aid eligibility, my T-STEM scholarship, if I am awarded one,
may be reduced. Receipt of this award will not affect my Pell scholarship, if I qualify for one.
Student Signature:________________________ Date:_____________
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T-STEM CHALLENGE SCHOLARSHIP APPLICANT CHECKLIST
Use this drop-down menu checklist to make sure that you submit all of the necessary TSTEM application packet documents.
Completed
Application Form
Completed
Application Questionnaire
Completed
Scholar Profile and Commitment Agreement
Completed
Official High School Transcript AND College Transcript (if college hours
have been earned)
Submit all of the above to the following office:
BROOKHAVEN COLLEGE
Development Office
Attn: Ngoc Truong
3939 Valley View Lane
Farmers Branch, TX 75244
ngoctruong@dcccd.edu
972-860-4182
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