WIDSC STEM Scholarship Application

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Are you a US Citizen?*

Yes
No

Are you a Florida Resident?*

Yes
No

Are you in the Military (Active or Reserve)?*

Yes
No

Is your Parent Active or Retired Military?*

Yes
No

Academic Information

Are you enrolled in a Post-Secondary School located in Brevard County?*

Yes
No

Current student status*

High School Graduating Student
Undergraduate Student
Graduate Student

Undergraduate class*

Freshman
Sophomore
Junior
Senior

Current unweighted GPA*

Earned college credits*

Name of College/University/Trade School*

Is this institution accredited by an accreditation body recognized by the Department of Labor?*

Yes
No

Major program(s) of study for college/university*

Use N/A if you will enter course title(s) below.

Minor program(s) of study for college/university*

Use N/A if you will enter course title(s) below.

Course title(s) for trade school/continuing education*

Use N/A if you entered Minor/Major programs above.

Anticipated graduation date*

Employment Information

List up to your last 3 employers. Include the name of the employer, your position/internship, the dates of your employment, and typical hours worked weekly.

Employer 1*

Position/Title*

Start date*

End date*

Number of hours worked*

Employer 2*

Position/Title*

Start date*

End date*

Number of hours worked*

Employer 3*

Position/Title*

Start date*

End date*

Number of hours worked*

Awards & Honors

Award 1

Awarded by

Date of award

Type of award

Award 2

Awarded by

Date of award

Type of award

Award 3

Awarded by

Date of award

Type of award

Volunteer/Community Service Information

Include any defense/national security, extracurricular, professional, or community activities during the last 12 months only.

Service 1

Start date

End date

Type of service

Service 2

Start date

End date

Type of service

Service 3

Start date

End date

Type of service

Recommendation

Provide the contact information for the person who is writing your letter of recommendation (required).

Name*

First Last

Title*

Organization*

Email*

Phone*

Required Attachments

PDF files only. Use the following format to name your attachments: LASTNAME_FIRSTNAME_LETTER and LASTNAME_FIRSTNAME_ESSAY

Letter of Recommendation*

Professional or Academic Recommendation (one). PDF file only. Use the following format to name your attachment: LASTNAME_FIRSTNAME_LETTER

Essay*

Essay is on one, 8.5” x 11”, page, 1” margin (all sides), 1.5” line spacing, Times New Roman 12 point font. Essay includes: statement of interest; description of principle accomplishments that relate to your professional goals including academic, professional, or community activities; and objectives of your educational program relating them back to your national security, defense, or STEM career plan. Essay is free of spelling errors, uses proper grammar, and is well organized. PDF file only. Use the following format to name your attachment: LASTNAME_FIRSTNAME_ESSAY

Consent

I agree that my submission is true and correct.

I hereby certify that all of the information contained in this application and supporting materials is true and correct to the best of my knowledge and belief. Providing misleading or incomplete information may disqualify me from scholarship consideration.

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Comments

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