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.
First Name: Middle Initial: Last:
Date of Birth:
City: State: Zip:
Home Phone (e.g. 989-555-1234):
High School Address:
City: State: Zip:
Year Graduating or Graduated from High School:
Guidance Counselor: Phone:
Grade point average/scale (e.g. 3.80/4.00):
Class Rank (e.g 15/385):
Number of High School core classes in :
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
List all scholarships and financial aid received OR applied for and the award dollar amount (e.g. All-State Scholarship, Applied, $500).
Optional: Description of family
financial need or special circumstances (e.g. other dependents in college,
unique financial situations)
List colleges Applied/Accepted to:
Do you have a parent that is a member
of the American Institute of Chemical Engineers? Select one.
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.
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