Department of Physics & Energy Science

Physics Tuition Scholarship 2007-2008 Application Form

This form must be filled out completely and returned to the Physics Department Office, Engr 206, along with a current copy of your transcripts and a personal statement by April 10, 2009. You must have officially declared Physics as your major to be eligible for this scholarship.

1. General Information

Name:	________________________________________________
Address:	________________________________________________
.	________________________________________________
Phone Number:	________________________________________________
Student ID number:	________________________________________________
email:	________________________________________________

Present academic standing (circle one):

Freshman

Sophmore

Junior

Senior

2. Transcript
Attach copies of transcripts for any college work which you have done (photocopies are OK).

3. Personal Statement
Attach a one page statement telling us about your interests in physics and what you would like to do after you finish your B.S. degree in Physics.

4. References
Please provide us with the names, addresses and phone numbers of three people who have agreed to serve as references for you. It is not necessary to get letters from them. We will contact them if require specific information.

Reference 1:	________________________________________________
Address:	________________________________________________
.	________________________________________________
Phone Number:	________________________________________________

Reference 2:	________________________________________________
Address:	________________________________________________
.	________________________________________________
Phone Number:	________________________________________________

Reference 3:	________________________________________________
Address:	________________________________________________
.	________________________________________________
Phone Number:	________________________________________________

5. Financial Aid Release (sign only if you would like financial need to be considered)
I authorize the Financial Aid office to release financial need information to the Physics Department for purposes of selecting recipients of this scholarship.

signature: _______________________________

Return application form and attachments to Physics Department Office, Engr. 206.