Scientists, Engineers, and Technicians Leadership Association, Inc. (SETLA)
2101 East Palmdale Blvd
Palmdale, CA 93550
Phone (661) 267-1501
www.setla2004.org
APPLICATION FOR SETLA SCHOLARSHIP
Note: Please read instructions on Page 5 before filling out this form. You may copy this form.
I am applying for scholarship support for (check one):
Undergraduate or Graduate Education
High School Senior or Graduate with a College Major selected
Examples of the programs of study which apply to the diverse fields of SETLA are any Science, Engineering,
Technical or related programs which will lead to careers in the fields of Science, Engineering, or Technology.
Name _________________________________________________________________________________
First
Middle
Last
Current Address _________________________________________________________________________
___________________________________________________ Phone _____________________________
Permanent Address ______________________________________________________________________
___________________________________________________ Phone _____________________________
Date of Birth ______________________ Place _______________________ Citizen of ________________
Email Address_____________________________________________________
Present status:
College applicants already enrolled:
College or University _____________________________________________________________________
I am in the ________ year of a ______ year curriculum and expect to graduate in ______________ (month)
of 20____ with a _____________________ Degree in ____________________________________ (major).
High school senior/graduate applicants:
I currently attend __________________________________________________________ High School.
I plan to attend __________________________________________________________ College/University
as a full time student beginning in _______________ (month/year), in a program leading to a
________________________________ Degree in __________________________________________.
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Are you a member of SETLA? _______ If so, for how long? ________
List anyone in your immediate family who is/was a member of SETLA _____________________________________
Note: You can apply for SETLA membership at www.SETLA2004.org
List the names of three persons from whom you have requested letters of reference, and indicate when those letters were
mailed to SETLA (See Item 3 in the Instructions on Page 5, below).
Name
Date
Mailed
Position and Organization
1
2
3
How did you learn about the SETLA Scholarship Program? _________________________________________
List all other scholarships which you have held, or now hold.
Scholarship
Sponsor
Years
Held
Still
Hold
Applied
for
Value
Scholastic Record:
Please complete the following, beginning with your high school education.
Scholastic Institution
Degree/Certificate
Years
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GPA
Class Rank/ # in Class
Work History: List significant employment and military experience (if any) since high school (most recent
first).
From
To
Hrs/wk
Activity, Location, and Nature of Work
(mo/yr) (mo/yr)
Describe your career aspirations, including your interests and objectives related to Science, Engineering
or Technology:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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Describe any relevant experience related to the above fields (include course work, as applicable):
________________________________________________________________________________________
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Page 3 of 5
________________________________________________________________________________________
List any supplementary information, or special circumstances, that indicate your particular worthiness
as a candidate for this scholarship:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Describe any organizational memberships that you now hold, or have held:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
List your hobbies and extra-curricular activities:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
In the event that I am awarded a scholarship, I hereby grant SETLA, and its authorized representatives,
unlimited access to my academic record. I also understand that the SETLA scholarship is granted with the
expectation that I intend on entering a career in the field of science, engineering, or technology.
To the best of my knowledge, the information provided is factual and complete.
Date: ________________Signature:_______________________________________
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INSTRUCTIONS—Please Read Carefully
1.
All applicants must be U.S. citizens.
2.
Scholarships are limited to the support of high school seniors and graduates, undergraduate education, or
during one year of graduate education leading to a master’s degree in an accredited college or university.
Scholarships will not be awarded to doctoral candidates or to applicants already holding advanced
degrees.
3.
Applications must be received by SETLA no later than 29 February 2016. U.S. regular mail will
be used, as SETLA does not keep regular office hours for drop offs. Sealed transcripts and
signed/sealed letters of reference are to be mailed to SETLA and can come under separate cover.
4.
Only completed applications, transcripts, letters of reference, and essays (see 5c below) will be
evaluated. No other information is required or desired. Applicants can complete application by hand
(legibly) or typed (if additional space is needed, it is acceptable to attach a sheet). No preference is
given to either handwritten or typed format.
5.
Applicants will provide their application to the Scientists, Engineers, and Technicians Leadership
Association (SETLA) Education Vice President Allan Smith, as well as:
a.
A copy of their academic transcript or report card for their past year of school.
b.
A list of their extra-curricular activities, including athletics, clubs, and any community service.
c.
A brief essay [~ less than 500 words] discussing how Science, Engineering, and/or Technology
have influenced their academic goals in a technical area.
6.
The selection of the winning applications will be based on the following:
a.
Academic performance
b.
Community and extra-curricular involvement
c.
Essay
d.
In-person interview, if desired, at the discretion of the Scholarship Committee
7.
Application and award process:
a.
Applications will be received by SETLA beginning January 1, 2016.
b.
The deadline for applications will be February 29, 2016.
c.
The Scholarship Committee will meet in April to screen the applications for eligibility.
d.
The Scholarship Committee will review the eligible applications and, at their discretion, select
applicants for interviews, if desired.
e.
The Scholarship Committee will notify the SETLA President and Board of Directors of all
selected winners no later than April 15.
f.
The Scholarship Committee is not obligated to award all available scholarships. Only
applications determined to be worthy and eligible will be considered. Winning applicants must
be accepted to and actually begin their post-secondary education program in order to be awarded
the scholarship funds. Any surplus or unawarded funds will be returned to the SETLA Treasurer
by the Scholarship Committee.
g.
The winning applicants will be notified at the earliest convenience of the Scholarship
Committee.
8. If a student declines a scholarship that has been awarded, the scholarship may be reallocated to the next
alternate on the list of that same year.
9. No late applications will be accepted.
All personal information received with the applications will be treated in accordance with the SETLA privacy
policy.
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