HARTFORD CHAPTER � ASM INTERNATIONAL

							           HARTFORD CHAPTER – ASM INTERNATIONAL
        MATERIALS SCIENCE AND ENGINEERING SCHOLARSHIP
                              “The Hartford Chapter Award of Excellence”
                                       $1,000.00 Stipend


Eligibility: An undergraduate student is eligible if:
         1) Registered full-time at University of Connecticut,
         2) Enrolled in the undergraduate program of the Department of Materials Science and
            Engineering
         3) A student in good academic standing.

All three of the above qualifications must be met to be eligible. Deadline is February 1st.


PLEASE TYPE or PRINT CLEARLY in BLUE or BLACK ink. Incomplete Scholarship Applications
will not be accepted.


NAME: ________________________________________________________________
Current Address (Street): __________________________________________________
City, State, Zip: __________________________________________________________
Home Address (Street): __________________________________________________
City, State, Zip: __________________________________________________________
Phone - Current: (    )____________________Home: (           )_____________________



1.      Educational Background:

High School: ____________________________________________________________
City, State: ______________________________________________________________
Graduated: ______________________________________________________________
UConn Major:________________________________________________________
Expected Graduation Date: _________________________________________________

2.      Employment Experience: (start with most recent)

A)      Dates: From ___________________________To: _________________________
        Employer: _________________________________________________________
        Address: __________________________________________________________
        Duties: ____________________________________________________________




                                                                                              December 15, 2004
                                                                                                             2



B)       Dates: From ___________________________To: _________________________
         Employer: _________________________________________________________
         Address: __________________________________________________________
         Duties: ____________________________________________________________

C)       Dates: From ___________________________To: _________________________
         Employer: _________________________________________________________
         Address: __________________________________________________________
         Duties: ____________________________________________________________

3.       Special Achievements – Honors and Recognition: (optional, as appropriate)


_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

4.      Career Objectives:
        Describe / Discuss (one separate page – single spaced type – attach to this application):
    How you originally selected materials science and engineering as your major.
    How you see integrating materials science and engineering into your career plans.
    How you would like to contribute to the field of materials science and engineering in the future.
    What would be your “dream job” in materials science and engineering in the future? Why?


5.       Attach a transcript or facsimile of your academic record.




Signature: _______________________________________ Date: __________________


Send Application and Attachments to:
                                        Prof. Rampi Ramprasad
                                         Scholarship Committee
                                    Materials Science and Engineering
                                       University of Connecticut
                                    97 North Eagleville Road U3136
                                         Storrs, CT 06269-3136
                                         Phone: (860) 486-2592
                                          Fax: (860) 486-4745


                                                                                              December 15, 2004