Welch Summer Scholar Program 2019 Nomination Form
• Applicants may be nominated by a teacher or counselor; family members are not eligible to nominate.
• This Electronic Nomination Form must be received no later than FEBRUARY 15, 2019 by 5:00 p.m.
• Students’ notifications will be e-mailed approximately mid-April.
• PLEASE NOTE: All communication with our Nominators and applicants is conducted by telephone or email (primarily email). Be sure to provide an email address that you check frequently.

Please indicate the student’s full name on all Nomination materials. Make sure it is the same name (if the student goes by more than one) as the student will be submitting with their own application.

The WSSP is held annually at 5 institutions in Texas:

Texas Tech University
The University of Texas at Arlington
The University of Texas at Dallas
The University of Houston
The University of Texas at Austin

The assignment of a scholar’s site location is made by the Selection Committee of Site Coordinators based upon predetermined criteria. Do not request to attend a specific site as these requests will not be considered.

Please fill in all information, even it is available on the student's transcript.

Applicant's FULL Name: Last, First, M.I. *
Your answer
Name of High School *
Your answer
School's FULL Mailing Address (Street, City, State, Zip) *
Your answer
Principal *
Your answer
Guidance Counselor *
Your answer
Science Department Chair *
Your answer
School's Telephone Number *
Your answer
Grades Taught *
Your answer
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