STUDENT APPLICATION FOR SLOAN SCHOLARSHIP

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1 ALFRED P. SLOAN FOUNDATION SLOAN INDIGENOUS GRADUATE PARTNERSHIP IN MATHEMATICS, SCIENCE AND ENGINEERING STUDENT APPLICATION FOR SLOAN SCHOLARSHIP To be eligible for this Sloan Scholarship, students must be American Indian, born in the United States, and be newly accepted into a masters or doctoral program at one of the participating university mathematics, science and engineering departments listed on page 3 of the attached application. Please submit this application and/or direct questions concerning program disciplines and procedures to the appropriate participating university contact below. Dr. Herb Schroeder Associate Dean of Undergraduate Studies & Professor of Engineering ANSEP Founder and Executive Director PI NSF Pacific Alliance, Room Providence Drive Anchorage, AK University of Alaska, Anchorage and Fairbanks Phone: (907) Dr. Maria Teresa Velez Associate Dean of the Graduate College University of Arizona Administration 302 Tucson, AZ Tel Fax Ms. Mary Kamensky Administrative Officer, Graduate School University of Montana 224 Lommasson Center Missoula, MT Tel Fax Ms. Cindy Dunstan Graduate School Administrator Montana Tech of The University of Montana Admissions Office MG 206 Butte, MT Tel Fax Please detach this sheet for your reference before submitting the attached application.

2 ALFRED P. SLOAN FOUNDATION SLOAN INDIGENOUS GRADUATE PARTNERSHIP IN MATHEMATICS, NATURAL SCIENCES AND ENGINEERING STUDENT APPLICATION FOR SLOAN SCHOLARSHIP APPLICANT INFORMATION Name Last Name First Name Middle Name Social Security Number Address Street Address City State Zip Code Telephone Daytime/Home (Please Circle) Cellular Primary Alternate Gender Tribal Affiliation Census/Tribal Registration # MOST RECENT DEGREE Designation Field Date College or University SUPERVISING SLOAN FACULTY/PROGRAM DIRECTOR University Department Sloan Faculty/Program Director Dr. Maria T. Velez Dr. Alexander Ross Dr. Joe Figueira Dr. Herb Schroeder Sloan Faculty/Program Director Signature Degree Program (please check one) : Master s Ph.D. Degree Program Entry Date Page 1 of 3

3 STUDENT APPLICATION FOR SLOAN SCHOLARSHIP (cont.) FINANCIAL COMMITMENTS AND CONTRIBUTIONS Please list below any known financial commitments or contributions you have received or will receive from your supervising department or faculty member (e.g., research assistantship, teaching assistantship, fellowship, etc.) Year 1 Year 2 Year 3 Year 3+ CONTACT INFORMATION Expected Fall Semester or Quarter Address and Telephone Number (If different from above): Street Address City State/Zip Telephone Number Please provide, for emergency situations, the names and telephone numbers of two (2) persons with whom you are in regular contact below. Name (Relationship) Telephone Number(s) Name (Relationship) Telephone Number(s) RESPONSIBILITIES OF SLOAN SCHOLARS As a Sloan Scholar, you will be expected to provide to NACME: a report on your academic progress at the end of every quarter/semester; an annual report every July on the expenditure of funds received from the Sloan Foundation; current address and telephone number every time these change while you are enrolled in the masters or Ph.D. program; and information about what position you accept upon graduation or departure from the masters or Ph.D. Program. Applicant Signature Date FOR NACME USE ONLY Status BL SS SPC Date Program Onset Grant Amount Dept/Unit Page 2 of 3

4 STUDENT APPLICATION FOR SLOAN SCHOLARSHIP Name University of Arizona Arizona Health Sciences Center Social Security Number Physics Planetary Sciences Speech and Hearing Sciences Cell Biology and Anatomy Biostatistics Epidemiology Medical Pharmacology Medicinal Chemistry Microbiology and Immunology Pharmaceutical Sciences Pharmacy College of Agriculture and Life Sciences Animal Sciences Arid Lands Resource Science Entomology Nutritional Sciences Pathobiology Plant Sciences Range Management Renewable Natural Resource Studies Soil, Water and Environmental Science Water Resources Administration Watershed Management Wildlife and Fisheries Science College of Engineering Aerospace Engineering Agricultural and Biosystems Engineering Chemical Engineering Civil Engineering Electrical and Computer Engineering Engineering Mechanics Environmental Engineering Geological/Geophysical Engineering Hydrology Industrial Engineering Materials Science Engineering Mechanical Engineering Mining and Geological Engineering Reliability and Quality Engineering Systems Engineering Systems and Industrial Engineering College of Science Applied and Industrial Physics Applied Biosciences Applied Mathematics Astronomy Biochemistry Biological Chemistry Chemistry Computer Science Ecology and Evolutionary Biology Geosciences Mathematics Mathematical Sciences Molecular and Cellular Biology Interdisciplinary Programs Arid Lands Resource Sciences Applied Mathematics Biomathematics Biomedical Engineering Cancer Biology Insect Science Neuroscience Optical Sciences Pharmacology and Toxicology Physiological Sciences University of Montana Biological Sciences Ecosystem and Conservation Sciences Forest Management Chemistry Computer Science Geology Geography Mathematical Sciences Environmental Studies (Scientific Concentration Only) Montana Tech of The University of Montana School of Mines and Engineering Environmental Engineering General Engineering Geological Engineering Geology Geophysical Engineering Hydrogeological Engineering Hydrogeology Industrial Hygiene Industrial Hygiene (Online) Metallurgical Engineering Mining Engineering Petroleum Engineering Project Engineering and Mgmt (Online) College of Mathematics and Science Geochemistry Interdisciplinary Master of Science Page 3 of 3

5 University of Alaska, Anchorage MS in Artic Engineering MS in Biology Ph.D. Biology MS in Civil Engineering MS in Computer Science MS in Engineering Management MS in Science Management MS in Project Management University of Alaska, Fairbanks College of Engineering MS and Ph.D. in Biology MS in Chemistry MS in Computer Science MS in Geoscience MS in Mathematics MS and Ph.D. in Physics Page 4 of 3

STUDENT APPLICATION FOR SLOAN SIGP SCHOLARSHIP

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