SCHOLARSHIPS FOR EXCELLENCE
COLLEGE OF ENGINEERING, TECHNOLOGY,
AND COMPUTER SCIENCE
APPLICATION DEADLINE
MARCH 1, 2007
APPLICATION DEADLINE IS MARCH 1, 2007.
(To be completed by student)
Name:__________________________________________________________
Last First Middle
Student Identification Number (optional):________________________________
High School:_____________________________________________________
Date: ____/____/___
I applied for admission to IPFW for the fall semester 2007 in the
Department of ____________________________________.
I am applying for a scholarship in the following program (mark the program to which you have applied for admission):
Department of Civil and Architectural Engineering Technology
___Architectural Engineering Technology
___Civil Engineering Technology
___Construction Engineering Technology
___Interior Design
Department of Computer Science
___Computer Science
___Information Systems
Department of Electrical and Computer Engineering Technology
___Computer Engineering Technology
___Electrical Engineering Technology
Department of Engineering
___Civil Engineering
___Computer Engineering
___Electrical Engineering
___Mechanical engineering
Department of Mechanical and Industrial Engineering Technology
___Industrial Engineering Technology
___Mechanical Engineering Technology
BOTH THE STUDENT PORTION AND THE HIGH SCHOOL TEACHER/COUNSELOR PORTION OF THE APPLICATION FORM MUST BE RETURNED TO:
Gerard Voland, Dean
College of Engineering, Technology, and Computer Science
Indiana University-Purdue University Fort Wayne
2101 E. Coliseum Blvd.
Fort Wayne, IN 46805-1499
260-481-6839 Please turn page over . . .
PERSONAL DATA:
In support of my application for an Engineering, Technology, and Computer Science Scholarship for Excellence at Indiana University-Purdue University Fort Wayne, I submit the following information:
1. Name: _______________________________________________________________________
Last First Middle
2. Home Address: _________________________________________________________________
Street
_________________________________________________________________
City State Zip Phone
3. Date of Birth:_________________________________________________________________
Month Day Year
4. High School Name and Address: ____________________________________________________________________________
____________________________________________________________________________
5. Parents' Full Names: ___________________________________________________________
6. Parents’ Address: ______________________________________________________________
_____________________________________________________________________________
7. Have you applied for financial aid for college? ___Yes ____No
8. What special recognition have you received for outstanding school work such as honors, prizes, or scholarships?
_______________________________________________________________________
_______________________________________________________________________
9. List the activities you have engaged in during your high school years. Include organized out-of-school activities (such as scouting, 4-H, church organizations, etc.) as well as those connected with school (class officer, athletics, publications, school organizations, etc.). Indicate the year or years you participated.
Activity Special Honors or Years of
Offices Held Participation
___________________ _________________________ ____________________
___________________ _________________________ ____________________
___________________ _________________________ ____________________
___________________ _________________________ ____________________
Please continue to next page. . .
10. Unfortunately it will not be possible to have personal interviews with all applicants. Would you,
therefore, write in the space below anything you would like to say if you were talking with the
Scholarship Selection Committee.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please continue to next page...
CERTIFICATION:
I certify that all statements contained in the foregoing application are true and correct, that I have applied for admission to IPFW, that I intend to enroll for the fall 2007 semester, and that I intend to complete a bachelor’s degree at IPFW. Further, I authorize the department to which I applied to provide GPA information to a company scholarship sponsor.
Signed:______________________________________________
(student)
Date: _____/_____/__
TRANSCRIPT:
Please include an official transcript of your high school grades.
RELEASE OF INFORMATION:
I authorize my school to provide information, including confidential transcripts of my grades, to the Scholarship Selection Committee.
Signed:__________________________________________________
(student)
Date: _____/_____/
APPLICATION DEADLINE:
This portion of the application along with the High School Teacher's/Guidance Counselor's portion must be returned by March 1, 2007.
TO ONE OF YOUR TEACHERS OR GUIDANCE COUNSELORS
The Selection Committee must rely heavily upon your estimate of the applicant's general ability and fitness for college work. For this reason, a statement is requested that will supplement the information given on the previous pages and assist the committee in its consideration of the candidate's qualifications. Please give details, in the form of incidents or examples, as you appraise the applicant with regard to leadership ability, citizenship, initiative, and strength of purpose. Finally, what are the qualities that most commend the applicant?
Please use the space below and back of page for your statement regarding the candidate's qualifications.
(_________________________________________)
Student’s Name
Signed:____________________________ Position:___________________________________________
Date: _____/_____/___ Address:___________________________________________________
Street
___________________ ___________________________________________________________
Area Phone City State Zip
Code Number
Please complete other side . . .
CONFIDENTIAL SCHOLASTIC AND PERSONAL DATA FORM
(To be completed by High School Guidance Counselor)
Since the Engineering, Technology, and Computer Science Scholarships for Excellence are awarded on the basis of "scholastic achievement and promise, and such personal qualities as character and leadership ability," the Selection Committee needs certain personal information about the candidate from the high school guidance counselors' office.
This is to certify that (Mr.)(Miss)___________________________________________________________________________
residing at__________________________________________________________________________
Address City State Zip
has attended the______________________________________________________________________
Name of High School
located at____________________________________________________________________________
City County State Zip
from___________________________________ to ___________________________________________
Month and Year Month and Year
and (check appropriate)
____ graduated _________________(month and year)
____ will probably graduate ______________ (month and year)
____ withdrew voluntarily from the school
Number of students in applicant's graduating class: ___________
Indicate the applicant's rank in graduating class: ___________
(If the applicant's exact rank in class is not available please give the approximate rank in class based on the subjects completed during the previous semesters.)
Has the applicant attended other high schools? ____ Yes ____ No
If yes, where?_________________________________________________________________
This application meets with my approval.
High School Teacher’s or Guidance Counselor’s signature:__________________________________
Print or type Teacher’s or Guidance Counselor’s name:_____________________________________
NOTE: So that the information may be kept strictly confidential, the Teacher/Counselor
Personal Data Form should be returned by March 1, 2007 directly to:
Gerard Voland, Dean
College of Engineering, Technology, and Computer Science
Indiana University-Purdue University Fort Wayne
2101 E. Coliseum Blvd.
Fort Wayne, IN 46805-1499
260-481-6839