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1 Page 1 of 6 Move through the form by clicking the Save and Continue buttons located at the top or bottom of each page. Edit any page by clicking the page link in the left navigation column. To submit, continue clicking the Save and Continue button until you receive onscreen messaging regarding successful submission. Application submission deadline: 5:00 p.m. Central Time on January 22, 2016 Recommender submission deadline: 5:00 p.m. Central Time on January 26, 2016 Profile Information Use the correct combination of uppercase and lowercase letters when completing the application. To avoid losing data you have entered, frequently click the Save button and always use the Logout link to exit. Do not use your browser's forward or back buttons. First name * First name is required Middle initial Last name * Last name is required Suffix (Jr., Sr., III, IV, etc.) Permanent Home Mailing Address Current address * Address is required Address line 2 City * City is required State * You must select a state ZIP code * ZIP code is required Contact Information Preferred * Primary is required Home phone * Phone number is required

2 Page 2 of 6 Other Information Date of birth * Date of birth is required Current age * Current age is required Gender * You must select a gender Citizenship * Citizenship is required State (or U.S. Territory) of legal residence * You must select a state If your legal residence is not the same as your parents, please indicate how it has been established. U.S. Congressional District If you do not know your congressional district, go to Enter your ZIP code to search for your U.S. Representative and the correlating Congressional District. All non-voting delegations such as American Samoa, District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands should select "At large" from the dropdown menu. Select the U.S. Congressional District for your legal residence. * You must select a Congressional District For Statistical Purposes Only Ethnicity Recommendation Requests Enter the addresses of three different people who know enough about you to assess your personal characteristics, motivation and potential for a research career in mathematics, the natural sciences or engineering. See Candidacy Information and Instructions for further details. Important Notes: Recommenders will not receive a request to complete their online recommendations until you have submitted your application. You are encouraged to submit as soon as possible. As soon as you submit your application, s will be generated and sent to your recommenders with instructions for completing the online recommendation. Inform your recommenders you will be requesting their help in completing the required application information. Your application will not be complete unless the recommendation forms are completed and submitted. Recommendation forms are due by January 26. You will be able to check the status of your recommendations from the My Portal page. Recommender *

3 Page 3 of 6 Recommender * Recommender * Career Goals/Professional Aspirations Career Goals In one or two sentences, describe your career goal (see example below). This statement will be used in publications if you are selected as a scholar or honorable mention. * Provide a more detail description of your career goals if you wish. Professional Aspirations What are your professional aspirations? Indicate which area(s) of mathematics, science or engineering you are considering pursuing in your research career and specify how your current academic program and your overall educational plans will assist you in achieving this goal. * Motivation Describe an activity or experience that has been important in clarifying or strengthening your motivation for a research career in science, mathematics or engineering. * Personal Information Goldwater Scholars will be representative of the diverse economic, ethnic and occupational backgrounds of families in the United States. Describe any characteristics or other personal information about yourself or your family that you wish to share with the selection committee. Activities Have you regularly participated in research activities associated with your interests in mathematics, science, or engineering? * Other Activities Activity Awards, Honors and Scholarships List any awards, honors and/or scholarships you have received. College Plans How many credit hours does your school require for graduation? * How many credits will you achieve as of January 1, 2016? * How many credits do you plan to achieve for graduation? * When do you expect to receive your baccalaureate degree? *

4 Page 4 of 6 For the next question, please note that your response must be in agreement with the response given by your Goldwater Faculty Representative. Sophomore is defined as a student who has two more years of full-time undergraduate study beginning September Junior is defined as a student who has one more year of full-time undergraduate study beginning September According to the definition provided above, indicate whether you are a sophomore or junior. * Provide your undergraduate major * Second major (if applicable) What area best represents your major(s)? * What will be your area/field of specialization? * Cumulative unweighted grade point average on a 4.00 scale for all college courses that have been taken. * List the name(s) of school(s) from which classes were taken that were used in the GPA calculation. * Current College or University Provide information on the two-year institution or four-year college or university you are currently attending. Postsecondary school name * Postsecondary school city * Postsecondary school state * Matriculation status at the institution you will be attending during the academic year * Institution type: * Start date * End date * Unweighted GPA on a 4.00 scale Were these college courses taken during high school? * Will you be providing a transcript from this school to your faculty representative? * Have you been enrolled at other colleges or universities? * If more than four months elapsed between high school and entry into college, please specifically state your activities during that time. Intended College and Major Provide information on the four-year college or university you will be attending during the academic year.

5 Page 5 of 6 Official school name * City * State * Degree Information What is the highest degree you plan to obtain * Coursework Major Courses - Current Enrollment Enter the courses in you major in which you are currently enrolled. List courses by title, not by catalog number used by your institution. Major Courses - Future Enrollment Enter the courses in your major for which you will enroll. List the courses by title, not by catalog number used by your institution. Courses Outside of Major Enter the math, science or engineering courses that are outside of your major for which you are enrolled or plan to enroll. Certification and Release I affirm that I am applying for a Barry Goldwater Scholarship. Permission is hereby given to officials of my institution to release transcripts of my academic record and other requested information for consideration in the Barry Goldwater Scholarship Program. I understand that this application will be available only to qualified people who need to see it in the course of their duties. I affirm that I plan to pursue a research career in mathematics, the natural sciences or engineering as defined and discussed in this application. I affirm that the information contained herein is true and accurate to the best of my knowledge.

6 Page 6 of 6 I agree that my name, current institution, career goals and state of legal residence may be publicly announced by the Foundation should I be awarded a scholarship or be named as an honorable mention. By entering my name below, I officially indicate my agreement and give my consent to the above terms and conditions of the Barry Goldwater Scholarship Program. Applicant's Signature * Click the Save and Continue button below when you are ready to submit your application. Review all of your responses. Continue clicking the Save and Continue button through the submission process. When your submission is successful, you will get an on-screen message confirming that the submission was successful. This site is administered by Scholarship Management Services, a division of Scholarship America. Terms of Use Privacy Policy