Energy Boost Undergraduate Scholarship Application Form
Students eligible to complete this application must 1) Be accepted into SIU's Department of Mechanical Engineering and Energy processes with the intent to complete an undergraduate degree as a full-time student, 2) Be a graduate from a high school in an Illinois county along or south of US50, 3) Provide an essay about how they have been personally impacted by the contraction in the coal industry, and 4) Provide a letter of reference and copies of most recent transcripts (unofficial OK). All of this information is described in more detail on the scholarship website (http://acerc.siu.edu/energyboost/scholarships/undergraduate.html). Contact acerc@siu.edu / 618-453-7327 for help. All application materials provided will be used for the sole purpose of determining eligibility and scoring of applicants for the intended scholarship for the next eligible period, and will not be otherwise shared or distributed. Institutions currently or previously attended as well as references provided may be contacted for additional information. Students may need to verify acceptance.
General Information
1. First Name *
Your answer
2. Last Name *
Your answer
3. SIU Email Address *
Your answer
Eligibility Information
4. Current/Intended College/Major* *
*Currently these scholarships are available to undergraduate students accepted into the College of Engineering's Department of Mechanical Engineering and Energy Processes.
Your answer
5. Please add the name and location of the high school from which you graduated. *
Example: Galatia High School, Galatia
Your answer
6. I understand that as part of the application I need to provide an essay describing how I have been personally impacted by the contraction in the coal industry, a letter of reference, and transcripts as described in the application procedure on the website. *
Required
Additional Information
7. Student Level at SIU as of Fall 2016 *
8. Awards: List awards, honors or special recognitions (high school or college) *
Your answer
9. List any 2-4 year schools you have attended since high school graduation, and any certificates or degrees attained. *
Your answer
10. Extracurricular Activities: List school related activities, volunteer experiences, and/or employment. Indicate leadership positions held (if any). *
Your answer
11. List any scholarships that you will be receiving or have received (please include the value per year for each scholarship). *
Your answer
Confirmations
12. I accept the terms and conditions of the award named in this application, and have read all associated documentation on the website. *
Required
13. 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. *
Required
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