ASCE Michigan Section Engineering Scholarships for Civil Engineering Students page 2 of 6
Applicant Information Name: Home Address: Scholarship Application The American Society of Civil Engineers, Michigan Section Engineering Scholarships for Civil Engineering Students Return completed application and a copy of the students current transcript to the ASCE Michigan Section by Memorial Day. Home Phone: Best way to contact applicant? (select all that apply) Email: Phone E-mail Are you a US Citizen and a Michigan Resident? Yes No Are you a student member of ASCE? Yes No Are you attending a Michigan School? Yes No Are either of your parents members of ASCE? Yes No If yes, what is his/her name? Parent's Branch affiliation: Scholarship Information I would like to be considered for the following scholarships: Mackinac Scholarship (must be entering Junior year in the fall of the year applying) Zuidema Scholrship (must be entering Junior or Senior year in the fall of the year applying) College Enrollment History ASCE Michigan Section Engineering Scholarships for Civil Engineering Students page 3 of 6
Financial Information Estimated Expenses for the Upcoming Year Tuition (including Fees): Room & Board (including Rent, Utilities, Food, etc.): Other (including transportation, insurance, etc.): Financial Support for the Upcoming Year Family Contribution: Student s Contribution: Other Scholarships: Student Loans: Grants: Other: Other Information Relevant to your Financial Need: Activities and Honors Describe participation in technical activities and leadership positions held (ASCE Student Chapter, Technical Societies or Clubs, etc.): ASCE Michigan Section Engineering Scholarships for Civil Engineering Students page 4 of 6
Describe participation in non-technical activities and leadership positions held (Athletic Teams, Band, Student Government, etc.): Describe academic honors, awards, recognitions, or special achievements (Dean's List, ASCE Awards, etc.): Describe paid employment during the school year, including weekly hours and duration of employment: Describe summer activities and summer employment, including weekly hours and duration of employment: Describe organized volunteer and community service projects, and results of volunteer activities: ASCE Michigan Section Engineering Scholarships for Civil Engineering Students page 5 of 6
Authorization I hereby authorize officials of my university to provide information concerning my academic records to ASCE. I hereby grant permission to ASCE to release information contained herein to other potential sources of scholarship assistance for engineering studies. I certify that all statements contained herein are true. Applicant's Signature Date Statement of Accuracy I hereby certify that the financial information provided in support of the applicant's statement of financial need is true and accurate and complete. Signature of Parent or Guardian Date University Official/Professor/Faculty Advisor Certification I hereby certify that the academic information and summary of activities as submitted in this application are correct and that the applicant meets the eligibility requirements as outlined. Printed Name Title University/College Phone Number Signature Date Required Attachment Please attach a current university transcript. Recommended Attachments Applicants are encouraged to include letters of reference from professors, ASCE Student Advisors, employers, etc. ASCE Michigan Section Engineering Scholarships for Civil Engineering Students page 6 of 6