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American Institute of Chemical Engineers

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Mid-Michigan AIChE Scholarship Application

Please fill out the following information, and then hit the Submit button.  Please only hit the Submit button once.  The Reset button will erase all the entries.  Please fill out the application at one sitting; you cannot save your data and return later.  We recommend that you plan your responses on a hard copy (available at the previous link) or prepare them off-line, then copy / paste into this form.

General Information

First Name:      Middle Initial:      Last: 

Date of Birth: 

Home Address: 

City:       State:       Zip: 

Email Address:      

Home Phone (e.g. 989-555-1234):  

High School: 

High School Address: 

City:       State:       Zip: 

Year Graduating or Graduated from High School:

Guidance Counselor:        Phone: 

Extracurricular Activities

  1. List all clubs, school activities, sports, etc. participated in during high school (briefly describe any awards, accomplishments, or positions of leadership.

  2. Describe any extracurricular and community activities (hobbies, sports, clubs, scouts, church, volunteer work, etc.) participated in during high school, and tell us why there are or were important to you.

  3. List all jobs held during high school (paid or not paid, hours worked, duties).

Academic Achievements

Grade point average/scale (e.g. 3.80/4.00):       

Class Rank (e.g 15/385): 

Number of High School core classes in :     

Math:        English:       Chemistry:       Physics:      
        
Computing: 
     Foreign Language: 

List any High School honors that you have received (Honor Roll, National Honor Society, etc.).

Provide the name of one High School teacher that you would offer as a reference.  Briefly describe why this teacher was chosen.

Financial Aid

List all scholarships and financial aid received OR applied for and the award dollar amount (e.g.  All-State Scholarship, Applied, $500). 











Approximate family income: 

Optional:  Description of family financial need or special circumstances (e.g. other dependents in college, unique financial situations)

Other

List colleges Applied/Accepted to: 

    

    

    

    

College you plan to attend, and why (20 words or less): 

Do you have a parent that is a member of the American Institute of Chemical Engineers?  Select one.   Yes No
 

How did you become aware of this scholarship (e.g. through family, counselor)?

Winners are invited to our Award Banquet to receive their award.  Generally your photograph is taken for our newsletter and Web site.   By checking this box, you authorize Mid-Michigan AIChE  to use your photograph in future Section newsletters and on the Web site. 
     
   I authorize Mid-Michigan AIChE  to use my photograph.

Essay Requirement

Describe in 500 words (or less) why you are interested in pursuing a degree in chemical engineering.  Also, please include any reasons why you should receive the Mid-Michigan AIChE Scholarship.


When you are finished and have reviewed your entries, press Submit.  By pressing the Submit button, you are claiming that all information in this application is complete and correct to the best of your knowledge.  Good luck.

 

   
   

Copyright Mid-Michigan Chapter of AIChE, 2004-2014

Address any comments about this Web page to the WebmasterMid-Michigan AIChE can also be reached via mail at Mid-Michigan AIChE, PO Box 2496, Midland, MI 48641-2496.