The T-STEM Challenge Scholarship Program is funded by the grant from the Texas Higher Education Coordinating Board.

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1 T-STEM APPLICATION (In College Student) Purpose The Texas Science, Technology, Engineering and Math (T-STEM) Challenge Scholarship program funded by the Texas Higher Education Coordinating Board at Cedar Valley College, DCCCD, provides funding for high-achieving, eligible students pursuing a degree in the STEM field disciplines. Please see page 5 for a list of eligible CVC T-STEM disciplines. Benefits Student selected as STEM Scholar will receive an opportunity to intern and explore careers and network with other STEM students, faculty and industry professionals. Student will be eligible for merit-based awards of $2,500 total over the academic year based on meeting eligibility and participation criteria. Please Note: if you apply for other financial aid (via the FAFSA application) and are eligible other awards may be adjusted if you are also awarded the T-STEM scholarship. Requirements Be a Full-Time Student with a cumulative 3.0 GPA or higher. (Males) Registered with the Selective Service System Service. Maintain a program of study leading to an AS or an AAS degree with Cedar Valley College. Will complete a minimum of 30 credit hours for the academic year you are applying for (fall, spring, summer) Participate by volunteering or interning 1-15 hour per week per semester in a STEM discipline that you have selected or under the guided program via CVC. Recommendation Letter from Math or Science Faculty. Application Documents. 1. Complete the STEM Application, select Program of Study (POS) in E-connect, 2. Official transcript. 3. Copy of Selective Services registry card. 4. Recommendation letter from a Science or Math instructor. CEDAR VALLEY COLLEGE Att: School Alliance, Selam Hailemariam L / shailemariam@dcccd.edu 1

2 T-STEM Challenge Scholarship Application Instructions Please complete the following sections. When completed, please sign, initial where requested, date and submit to the office identified on page 1 of this packet. Applicant Information First Name: Last Name: DCCCD Student ID# : Date of Birth: Home Address: :City: State: Zip: Home Phone: Primary Address: *The Primary Address you provide here will be used as a central source of communications with the Cedar Valley College. You agree to check your primary to review any messages from the CVC STEP Program. You also agree to notify the CVC STEM program immediately of any changes in your Primary Address. Academic Information Intended STEM Major (see page 5 of application): College Credit Hours Earned to Date: Cumulative College Hours GPA: Have you registered with the Selective Services System? Do you intend to take credit hours each semester (summers 6 hours) Do you intend to graduate from DCCCD with an AAS or AS degree? I release to the Dallas County Community College District (DCCCD) and the CVC STEM program the right to access all my current and ongoing personal and academic records and transcripts. If awarded a student support award, I understand that I must meet the award criteria and Standards of Academic Progress for the DCCCD and the CVC STEM program. I understand my name and information from my academic history may be released to the student support award selection committee(s) and the student support award donor(s). If awarded a student support award, I release to the DCCCD and the CVC STEM program, the right to arrange a meeting with the donor(s) and use my name, story, and picture for printed and video materials, reports, and press releases, without compensation, as well as I will attend ceremonies and receptions. Authorization and Information Date: (Your initials) 2

3 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 student support award selection committee(s) and student support award donor(s) Student Signature: Date: CVC STEM APPLICATION QUESTIONNAIRE (Your answer is used for informational purposes and will not impact the decision of the selection committee) from DCCC It is recommended that type your answer to these questions on a separate page and attach your answer page(s) to the application. 1. In one or two lines describe what your career goal(s) are as a STEM Professional? 2. In one or two lines describe the reasons for your interest in the STEM field. 3. In one or two lines describe what you hope to accomplish as a professional in a STEM field? 4. In one or two lines what would be most valuable to you as a STEM Scholar and why? 3

4 PROFILE AND COMMITMENT AGREEMENT STEM SCHOLAR PROFILE INFORMATION (Please type or print clearly.) Name: DCCCD Student ID#: Phone Number(s): Primary Address: Declared STEM field or primary area of study: DCCCD College Attending: Will you be employed during the academic year you are applying for? Full- -time If yes: Are you receiving financial aid or any additional awards other the Pell during the academic year you are applying? YES. NO. (student only getting Pell award are not affected) NOTE: Students that are eligible for the following awards (TEXAS Grant, Federal Supplemental Education Grant, Work-Study, Subsidized Loan etc.) may have their award adjusted if also awarded the T-STEM. STEM SCHOLAR COMMITMENT AGREEMENT Please review the requirements of the STEM Institute 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 the award. I will maintain a program of study with DCCCD in an approved STEM field (see the list on page two). I have a 3.0 GPA or higher and I agree to maintain a cumulative 3.0 GPA or higher through the academic year. I agree to complete a minimum of credit hours each semester (fall and spring academic year). I understand that failure to meet these requirements will result in a reduction or loss of my award. Initial Your Signature: Date: 4

5 STEM AND RELATED FIELDS T-STEM ELIGIBLE INSTRUCTIONAL PROGRAMS T-STEM Instructional Programs are a defined set of courses that lead to the award an associate degree in the following U.S. Department of Education Classification of Instructional Programs or specified by the college. Computer and Information Sciences and Support Services (AAS) COMPUTER GRAPHICS Engineering Engineering Technologies/Technicians); Biological Sciences Mathematics and Statistics ACCOUNTING Physical Sciences: Multi/Interdisciplinary Studies, Biological and Physical Sciences Veterinary Technology (AAS Degree) Residential Building Performance Technology (AAS Degree) AIR CONDITIONING AND REFRIGERATION-RESIDENTIAL (AAS Degree) T-STEM OCCUPATION FIELDS T-STEM Occupation Fields serve as a guide for part-time employment for active T-STEM scholarship recipients and for continued eligibility of an Awarded Applicant based on the employment of graduates. T-STEM Occupation Fields are a set of employment specialties as defined by the Bureau of Labor Statistics as Standard Occupational Classification (SOC) Titles and include: Computer and Mathematical Occupations Engineers Engineering Technicians Life Scientists 5