QUAD CITY ENGINEERING AND SCIENCE COUNCIL 2015 APPLICATION FOR SCHOLARSHIP

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1 P.O. Box 1166 Bettendorf, IA QUAD CITY ENGINEERING AND SCIENCE COUNCIL 2015 APPLICATION FOR SCHOLARSHIP APPLICANT: ADDRESS: TELEPHONE: CONTACT: Gender: PLEASE MAIL COMPLETED APPLICATION; POSTMARKED BY JANUARY 23, 2015 QCESC Attn: Scholarship Committee P.O. Box 1166 Bettendorf, IA Requirements for Eligibility 1. Must be a high school senior. Also must be a resident of Mercer, Rock Island, Henry, Whiteside, Carroll, Knox, Lee, Clinton, Scott, Muscatine, or Louisa County. 2. Must plan to study STEM related degree (Science,Technology,Engineering or Mathematics) at an accredited four-year college or university. For definition of stem degrees see page 7 Description of Scholarship The Quad City and Engineering Science Council Scholarship Program was established and is administered by the Council. This program provides multiple one-time grants/scholarships between $1000 and $3000 each. These are awarded on an objective basis without regard to race, sex, or religion. Criteria include academics, civic/community service, extracurricular involvement, career goals, and an essay on why you want a STEM degree. Funds from this grant must be applied to tuition or fees related to eligibility item 2. Additionally, scholarships from several Engineering Colleges may be available via this form. (see page 6) Award Presentation Scholarships awards will be presented at the Annual Engineers Week Banquet on, or about February 26, The scholarship winners and one parent each will be the guests of the QCESC at the annual awards dinner. Additional family members are encouraged to attend at the regular meal price; contact Tom Hein for details. Winners will be requested to provide a photo for publication with the award announcement in the QC local newspapers and on the QCESC website. Note: This form can be completed and printed for mailing as a MS Word Document (DOC) from the QCESC website at under QCESC Information (scholarships). An Adobe Acrobat (PDF) file is also available for printing copies to fill out by hand or typing (typing is recommended). For additional information or assistance, contact Tom Hein at mailto:tkhein@gmail.com or Telephone (309)

2 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 2 EMPLOYMENT: Are you presently employed? Paid Volunteer Hours per week > <5 Summer If yes, name of employer Phone ( ) Type of work performed HIGH SCHOOL INFORMATION: The information requested must be completed and verified by a representative of your school. ACT Composite Score High School Senior Grade Point Average High School Senior Class Rank Number in Class High School Name Expected Date of Graduation Signature of High School Representative Title Please attach Transcript COLLEGE INFORMATION: Name of four year schools you plan to attend and their location Course of Study Major Minor If you want to be considered for a university sponsered scholaraship, check and rank your choices see page 6 for details. To receive the scholarships, you must apply and be accepted into their College of Engineering Iowa State University University of Iowa University of Illinois - Chicago University of Wisconsin - Platteville Western Illinos University Quad Cities # # # # # # St.Ambrose University

3 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 3 OTHER INFORMATION: 1. List extra-curricular activities you have participated in during the past three years or are now participating in and the offices held: 2. List any achievements, special awards, etc., you have accomplished or received during the past three years: STEM Activities Project Lead the Way FLL FTC FRC Others?

4 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 4 3. List any community related activities you have participated in during the past three years 4. State briefly your career goals and how you plan to accomplish them: 5. List any arrests and convictions excluding minor traffic violations: (If none, write none )

5 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 5 6. In the space provided, explain why you would like to obtain a degree in Engineering or Science. This essay is often the key differentiator for selection I (we) certify that all answers to the preceding questions are true and correct. I (we) understand that any false answers or deliberate omissions on this application may be grounds for rejection of this application and withdrawal of any award granted. I (we) authorize investigation of the applicant s employment, schooling, and other activities and release those persons, organizations, or companies supplying information from all liability and responsibility for any damages I (we) may suffer as a result of this information. I (we) agree that I (we) will abide by all decisions made by the Quad City Engineering and Science Council. Applicant s Signature Parent or Guardian Signature (if applicant is a minor; if applicant is over 18, then write N/A in this box). Date Date

6 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 6 Additional Scholarship Information For the 7 th consecutive year, in addition to scholarships from the QCESC and its member societies, scholarships will also available from the following Engineering Colleges: Iowa State University (2 x $1,000 scholarships) University of Iowa (1 x $1,000 scholarship) University of Illinois Chicago (1 x $1,000 scholarship) University of Wisconsin Platteville (1 x $2,500 scholarship) Western Illinois University Quad Cities Campus (1 x $1,000) St. Ambrose University (1 x $2,000) To be considered for one of these scholarships in addition to the QCESC scholarships, please indicate your interest in the SCHOOL INFORMATION box on page 2 of this application. These scholarships are administered directly by the College of Engineering at these Universities; the QCESC selects and recommends applicants to the colleges. To receive the scholarships, you must apply and be accepted into their College of Engineering. Additional Requirements for University of Iowa and Iowa State University: Applicants are required to have participated in PLTW and robotics Contact Tom Hein (see contact information on page 1) for more information and availability of these scholarships.

7 QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 7 STEM Related Degrees An exhaustive list of STEM disciplines does not exist, but the U.S. Immigration and Customs Enforcement lists disciplines including: [6] Physics Actuarial Science Chemistry Mathematics Statistics Computer Science Psychology Biochemistry Robotics Computer Engineering Electrical Engineering Mechanical Engineering Industrial Engineering Civil Engineering Aerospace Engineering Chemical Engineering Astrophysics Astronomy Nanotechnology Nuclear Physics Mathematical Biology Operations Research Neurobiology Biomechanics Bioinformatics Acoustical Engineering Geographic Information Systems Atmospheric Sciences The National Science Foundation is the only American federal agency whose mission includes support for all fields of fundamental science and engineering, except for medical sciences. [7] It lists its disciplinary program areas as: Biological Sciences Computer & Information Science & Engineering Education and Human Resources Engineering Environmental Research & Education Geosciences International Science & Engineering Mathematical & Physical Sciences Social, Behavioral & Economic Sciences Cyberinfrastructure Polar Programs