AGI MINORITY GEOSCIENCE STUDENT SCHOLARSHIPS INFORMATION AND

graduate student majoring (i.e., degree candidate) in geoscience, including the geoscience subdisciplines of geology, geophysic s, geochemistry, hydrology, meteorology, physical oceanography, planetary geology, or earth-science education. This program does not support students in other natural sciences, mathematics, or engineering.<br><br> D. The program is currently open to all qualified applicants. APPLICATION PROCEDURES A.<br><br> Incomplete applications do not qualify for consideration. Before an application will be considered, the following materials must be received at AGI no later than March 1: " signed and fully completed application form (4 pages); " official transcripts for all colleges attended (SAT, ACT, and/or GRE scores are requested); " three (3) letters of recommendation from persons qualified to judge the applicant's recent academic performance and character : geoscience faculty/employers are preferred, other science/mathematics faculty are acceptable. B.<br><br> Current recipients of AGI Minority Geoscience Scholarships must re-apply for renewal of a scholarship. Renewal applications should include completed application, transcripts for their current academic institution, and three (3) letters of recommendation including at least one not included in the previous application. The "statement of purpose" (application, pg.4) should be used to describe current academic progress and plans.<br><br> NOTE: Scholarships are not automatically renewed. C. Complete the application in dark ink or type.<br><br> D. All letters of recommendation should be sent directly to the address above, ATTN: Minority Geoscience Student Scholarship Coordinator. E.<br><br> It is the applicant's responsibility to be sure that all application materials are submitted. AGI MINORITY GEOSCIENCE STUDENT SCHOLARSHIP APPLICATION 2005-2006 Due March 1, 2005 1. PERSONAL INFORMATION Name _____________________________________________________________ Birthdate _____________ Sex: F M (last) (first) (m.i.) Permanent Address _______________________________________________________________________________________ _____________________________________________________ Phone (____)_______________________ Address during school year________________________________________________________________________________ ______________________________________________ Phone (____)_______________________ Social Security Number _______________________ Ethnic Group: Black Hispanic Native American* U.S.<br><br> Citizen? Yes No *Specify (you may be asked to verify this information) 2. EDUCATION My current academic status is: College Freshman Sophomore Junior Senior Grad Student I am a: Full time student Part time student Not presently enrolled (If not enrolled, please explain) High School Name__________________________________________________________________________________________________ Address________________________________________________________________________________________________ What was your class standing?<br><br> _________ out of _______ or percentile _________% Honors or awards?________________________________________________________________________________________ College DepartmentDate Entered Degree Sought Overall GPA Math/Science GPA Graduation Date First College Second College Third College College Test Scores: ACT________________ SAT_________________ GRE__________________ (Enclose or send record.) Thesis Topic(s):__________________________________________________________________________________________ College Honors or Awards:________________________________________________________________________________ _______________________________________________________________________________________________________ Extracurricular Activities:__________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 3. RECOMMENDATIONS Letters of Recommendation have been requested from: NameMailing Address 1. __________________________________________________________________________________________________ 2.<br><br> __________________________________________________________________________________________________ 3. __________________________________________________________________________________________________ 4. WORK EXPERIENCE (List most recent first.<br><br> Include volunteer work) Employer_______________________________________________________________________________________________ Duties ______________________________________ Hours/Week ____________ Dates of Employment __________________ Employer_______________________________________________________________________________________________ Duties ______________________________________ Hours/Week ____________ Dates of Employment __________________ Employer_______________________________________________________________________________________________ Duties ______________________________________ Hours/Week ____________ Dates of Employment __________________ Employer_______________________________________________________________________________________________ Duties ______________________________________ Hours/Week ____________ Dates of Employment __________________ 5. FINANCIAL INFORMATION Complete Parts A, C, D, and E if you are a DEPENDENT (i.e., If you are declared as a tax exemption by a parent or guardian) Complete Parts B, C, D, and Eif you are financially INDEPENDENT. All questions on required parts must be completed in full for your application to be considered.<br><br> Part A. Name and address of parent or guardian: Last name First name Address ____________________ _______________________ _________________________________________________________ Number of dependents in household _______________ Household gross income $_______________/yr. Total support received from parent $_______________ Part B.<br><br> Marital Status________________ Number of dependents claimed on income tax ________________ Spouse's gross income $________________/yr. Part C. Estimated income for the NEXT academic year 1.<br><br> Parent 9s Contribution$ ______________________________ 2. Spouse 9s Contribution$ ______________________________ 3. Scholarship Stipends$ ______________________________ 4.<br><br> Fellowship Stipends$ ______________________________ 5. Assistantship Stipends$ ______________________________ 6. Other Personal Earnings$ ______________________________ 7.<br><br> Tuition remission/waiver$ ______________________________ 8. Fee waiver$ ______________________________ 9. Loans$ ______________________________ 10.<br><br> Grants$ ______________________________ 11. Scholarships (non-AGI)$ ______________________________ 12. Fellowships$ ______________________________ 13 Other (specify) $ ______________________________ TOTAL INCOME $ ____________________________ Part D.<br><br> Anticipated Expenses for NEXT academic year: 1. Tuition and Fees$ ______________________________ 2. Room and Board$ ______________________________ 3.<br><br> Books and Supplies$ ______________________________ 4. Other (be specific)$ ______________________________ _______________ _______________ _______________ TOTAL EXPENSES $ ______________________________ Part E. Total amount requested from the American Geological Institute:$ ______________________________ 6.<br><br> PERSONAL STATEMENT In the space below in 250 words or less, tell why you have chosen one of the geosciences as your major in college and state you r career goals. Your statement should be typed or printed in dark ink. You may prefer to prepare your statement on a separate sheet of paper, which you should then attach to this space.<br><br> 7. AFFIDAVIT I hereby certify that I am a Black, Native American, or Hispanic United States Citizen. I certify that this application contain s no misrepresentations or falsification, and that the information given by me is true and correct to the best of my knowledge.<br><br> I understand that any false statements made herein will void this application and I will be ineligible for financial support from the American Geological Institute. * Eligible Native Americans include American Indian, Eskimo, Hawaiian, and Samoan. SIGNATURE OF APPLICANT ____________________________________________ DATE ________________________<br><br>

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