NSF-CSEMS APPLICATION FORM Erik Jonsson School of Engineering and Computer Science Scholarship Awards for 2008 – 2009 Academic Year Applicants MUST submit the following documents to the Financial Aid Office, McDermott Library (MC1.304 – Lower Level), by April 28, 2008 to be considered for this scholarship. 1. This fully-completed application form. 2. Two letters of recommendation (see Recommendation Form) 3. A one-page Personal Statement (see description below) 4. If you think you may qualify for a need-based scholarship, you MUST complete a 2008-2009 Free Application for Federal Student Aid (FAFSA) (UTD Title IV school code is 009741). Applicant Name: ______________________________________________________________ First Middle Last Applicant UTD Email address: firstname.lastname@example.org UTD NetID Note: Scholarship awards will be announced during the second week of the Fall 2007 semester using your official UTD email address. You must respond to this email indicating your acceptance of the award. Social Security Number: ______-_____-________ Your social security number (SSN) is being requested because it is a unique identification number which is maintained to assure that the correct student record is being updated, for tracking purposes and for state and federal reporting requirements. The disclosure of such information is voluntary. Disclosure of your social security number will be governed by the Public Information Act (Chapter 552 of the Texas Government Code). A) Employment History (beginning with current or most recent); continue on back of form if required Job Title Duties Employer City, State Dates Worked B) List awards, honors, or memberships (ACM, SWE, etc.) ; continue on back if required E) Personal Statement (limited to one single-spaced, typed page) Please attach a one-page essay. Include a statement of your educational goals and career objectives. Describe computer science or software engineering projects you have completed. Explain how the CSEMS Program will affect your educational and career plans. I understand that if I am offered and accept this scholarship, I must remain enrolled full-time at UTD with a CS, SE, or CS/SE major, I must meet with a faculty advisor during each semester I am funded, and I must complete any requested surveys or other assessment tools related to this scholarship. To the best of my knowledge, I certify that all of the above information is correct. I understand that my signature below gives permission for the NSF CSEMS Committee to review any academic records and any information pertaining to my eligibility for Federal Financial Aid. I further consent to the release of such information for reporting purposes to the NSF. APPLICANT SIGNATURE_________________________________________________DATE _______________ With few exceptions, you are entitled at your request to be informed about the information UTD collects about you. Under Sections 552.021 & 552.023 of the TX Govt. Code, you are entitled to receive and review the information. Under Section 559.004 of the TX Govt. Code, you are entitled to have UTD correct information about you that is held by us and that is incorrect.
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