Student Services

C2STEM Transitions Grant Scholarship Application Scholarship is sponsored by Texas Space Grant Consortium through funding from the National Space Grant and Fellowship program in conjunction with The University of Texas at Austin Deadline: December 4, 2016. Scholarship Requirements: 1) Student must be a citizen of the United States. 2) Student must be an enrolled ACC student pursuing a degree or certificate in an aerospace or STEM field. 3) Student must be enrolled in a minimum of 6 credit hours as a part-time student or 12 credit hours as a full-time student. 4) Student must have completed at least 15 credit hours with a minimum GPA of 2.9. 5)Student must have completed 8 credit hours of coursework in science, math, engineering, or technology. General Scholarship Information: 1) Multiple scholarships will be funded each semester ranging from a minimum of $500/semester for parttime (6 credit hours) students and $1,250/semester for full-time (12+ credit hours) students. 2) Scholarship may be used for tuition, fees, books or other training costs and will be paid after the successful completion of the semester. 3) Scholarship is renewable for additional semesters based on successful completion of prior semesters. Initial scholarship application MUST include: 1) This C2 STEM Transitions Grant Scholarship application and all required essays / statements requested therein; 2) Copies of your unofficial academic transcript(s) from each high school and college that you have attended; official transcripts will be required, if awarded. 3) Two letters of recommendation. These letters MUST be from an instructor, counselor, community member, or employer. Letters of reference from a classmate/friend/parent are not acceptable. Letters should be in a sealed envelope with writer’s signature across the seal. 4) Copy of birth certificate or US Passport 5) Copies of receipts for all books, required supplies and training expenses purchased for this semester. Request for subsequent semester scholarships are allowed and MUST include: 1) Student must submit a letter of request for additional scholarship consideration and update the C2STEM application information. 2) Provide official transcripts of grades from the student’s prior semesters while in the scholarship program. Personal Data Name: ____________________________________________________ Student ID Number: ______________ ( Last, First, Middle Initial )

Current Address: ___________________________________________________________________________ City: _______________________________________________ State: _________

Zip: _____________

Phone: _____________________________ Personal email: ________________________________________ Permanent Address: ________________________________________________________________________ City: _______________________________________________ State: _________

Zip: _____________

Permanent Phone: ______________________________ Cell Phone: __________________________________ ACC email: ______________________________________________________________________ JC 3750-01

Are you a US Military Veteran? Yes  No have a disability?

Are you actively on duty in the US Military? Yes  No Do you

Yes  No STSE.069.0116

Financial Information Have you applied for Federal Financial Aid (FAFSA) for the upcoming academic year?

 Yes

 No

NEED FOR FINANCIAL ASSISTANCE - On a separate sheet of paper, please write a statement describing why you need this financial assistance (500 word minimum).

Educational Background School currently attending/last attended: _______________________________________________________ The above listed school is a: (please check one)  High School  Two-Year College

 Four-Year College

 Graduate School

Please list all high schools and colleges attended: School

Dates Attended

Degree

GPA

1.

__________________________________________________________________________________

2.

__________________________________________________________________________________

3.

__________________________________________________________________________________

Are you currently enrolled at Austin Community College?

 Yes

 No

What is your intended major/field of study/specialization? _________________________________________ How many credit hours have you completed as of today? __________________________________________ How many credit hours have you completed in Science, Math, Engineering or Technology courses? ________ What is your cumulative GPA? _______________________________________________________________ What is your anticipated completion/graduation date from ACC? _______________________________ Do you plan on transferring to a University upon completion?

 Yes

 No

If so, which university and into which major? ___________________________________________________

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STSE.069.0915 Additional Information List any awards, honors, prizes, scholarships, etc. that you have received: _________________________________________________________________________________________ _________________________________________________________________________________________ List any extracurricular activities, club memberships and leadership positions Including high school, college, volunteer and community _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Provide a summary of work experience (attach a resume if you wish): Employer

Position/Duties

Dates of Employment

_________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

TRAINING/OCCUPATIONAL GOALS PERSONAL STATEMENT - On a separate sheet of paper, please describe your training and occupational goals, why you're applying for this scholarship, and anything else you want the committee to know about you (750 word minimum). IMPACT STATEMENT - On a separate sheet of paper, please provide an impact statement of no more than one-half page describing the impact this scholarship would have on helping you achieve your goals.

*****PERMISSION FOR RELEASE OF ACADEMIC RECORDS & STUDENT INFORMATION AND UNDERSTANDING OF SCHOLARSHIP REQUIREMENTS***** I hereby certify that the information provided is true and correct to the best of my knowledge. I authorize Austin Community College to release the information contained within this application (including academic records and personal biographical information) to the awarding scholarship committee and agencies/donors providing for this scholarship. I understand the names of scholarship award recipients may be published in area newspapers and recipients may be asked to provide a photograph. Non-compliance with eligibility requirements of the scholarship may result in the reimbursement of monies to the Aerospace Scholarship Fund. Any debts owed to Austin Community College must be paid prior to the disbursement of scholarship monies. Student signature: _____________________________________________

Date: _______________________

RETURN THE COMPLETED APPLICATION AND ATTACHMENTS TO: [email protected] , or by mail at Austin Community College Scholarship Coordinator 5930 Middle Fiskville Rd Austin, TX 78752. STSE.069.0915

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