UM Microelectronics First Year Scholarship Application

First Year Microelectronics Scholarship Application Form
2010 - 2011 Academic Year

Application Deadline: Monday 15 March 2010

This form is to be used by high school seniors applying for a First Year Microelectronics Scholarship. When you click the submit button on this form, an email copy of your application will be sent to the College of Engineering at UMaine. Your submitted information will then be displayed, along with a release that indicates your willingness to grant access to your academic records to the UMaine Microelectronics Consortium Committee. This committee consists of members of the UMaine faculty and representatives of the consortium companies. You must print out the completed form displayed to you, sign it, and send it to the address indicated. The deadline for submitting the electronic form is 23 February 2009. The permission form must be received within a week of the electronic deadline.

Please fill in all data fields. Incomplete information may invalidate your application.

Personal information

Last name
First name and middle initial
Today's date (mm/dd/yyyy)
   
  Current (local) address
Street
City
State
Zip
Day phone
Social Security # (optional)
Birth Date (mm/dd/yyyy)
Email address

High school from which you will graduate or have graduated

Name

Address

Graduation date

(mm/yyyy)

Class rank =

out of as of (mm/yyyy)

SAT Score

(verbal) + (math) = (total)

References (science or math teachers, counselor, principal)

Name Position Work telephone number Email address

Academic Honors (national merit sernifinalist, national honor society, honor roll, science award, etc.)

Activities, sports, student organizations (include any offices held)

Most recent employment (summers and during school)

Date Job began (mm/dd/yyyy) Date Job Ended (mm/dd/yyyy)

Job Description/Employer