Energy Boost Scholars Application Form
Contact acerc@siu.edu / 618-453-7327 for help. Information provided here will be used to determine eligibility and scoring for the award, and to verify current enrollment. Visit the website for complete information: http://acerc.siu.edu/energyboost/grants/scholars/.
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1. First Name *
2. Last Name *
3. SIU Email Address *
4. Current College and Major *
E.g. Engineering, Mechanical Engineering and Energy Processes
5. Current Year *
Freshman, Sophomore, Junior, Senior
6. Do you have a faculty mentor? *
7. Are you applying as an individual or for your RSO? *
Please enter "Individual" or the complete RSO name.
8. Awards: List awards, honors or special recognitions (high school or college) *
9. Extracurricular Activities: List school related activities, volunteer experiences, and/or employment. Indicate leadership positions held (if any). *
10. List any scholarships that you will be receiving or have received (please include the value per year for each scholarship). *
11. I accept the conditions of the award described in this application. I signify that the information supplied for admission to Southern Illinois University Carbondale is true and accurate, to the best of my knowledge. Further, I understand my obligation to notify SIUC in writing as soon as possible if I modify my decision to enroll. As a recipient of an academic award from Southern Illinois University Carbondale, I understand that the University has the legal authority to release my name and address, the name of my former high school or college, the name of my award, and the award amount. This release is valid for the period of time the award is in effect. *
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