California State University, San Bernardino

Computer Science, Engineering, Mathematics Scholarship
Application Form

Name:__________________________________________ Date:_______________________

Address:________________________________________

_______________________________________________

Telephone Number:________________________________

Email:__________________________________________

Social Security Number:____________________________

Citizenship Status (check one): ( ) U. S. Citizen ( ) National ( ) Refugee Alien ( ) Permanent Resident Alien

California Resident: ( )Yes ( ) No

Undergraduates, have you submitted a Free Application for Federal Student Aid (FAFSA)?

( ) Yes ( ) No

Submit the Completed Application Package (Scholarship Application Form, essay, letters of recommendation, and copy of FAFSA award letter ) to the CSEMS representative for your department listed below:
 
  Computer Science

Yasha Karant/CSEMS
Department of Computer Science
California State University, San Bernardino
5500 University Parkway
San Bernardino, CA 920 University Parkway
San Bernardino, CA 92407-2397
 
  Mathematics
Joe Chavez/CSEMS
Department of Mathematics
California State University, San Bernardino
5500 University Parkway
San Bernardino, CA 92407-2397
 
  Physics
Karen Kolehmainen/CSEMS
Department of Physics
California State University, San Bernardino
5500 University Parkway
San Bernardino, CA 92407-2397
 

California State University, San Bernardino

Computer Science, Engineering, Mathematics Scholarship
Essay Form

Type a brief essay discussing your professional goals and explaining why you should receive a CSEMS scholarship. Applicants are advised that evaluation of your scholarship application shall be based in part on content and composition of this essay.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

I give California State University, San Bernardino permission to release this information to the NSF, if required.

I give California State University, San Bernardino permission to publicize my schoState University, San Bernardino permission to publicize my scholarship award should I be a recipient.

I understand that if I receive a scholarship, I must carry a minimum of 12 units credit each quarter for the duration of the scholarship.

I certify that the information provided on this application is complete and accurate.

___________________________________
Signature of Applicant

_______________________
Date

California State University, San Bernardino

Computer Science, Engineering, Mathematics Scholarship
RecommendationLetter (Non-Confidential)

Name of Applicant___________________________________ SS#_____________________________

1. How long have you known the applicant and under what circumstances?
 
 
 
 
 
 
 
 
 

2. How would you rate the applicant in comparison to all other students you have known in the past three years? (e.g., the upper 5%, 10%, 25, etc.).
 
 
 
 
 > 
 
 
 
 
 
 
 
 

3. Why do you recommend the applicant for a scholarship? What qualities, personal characteristics, and interests does the applicant possess which make her/him outstanding among other students?
 
 
 
 
 
 
 
 
 
 

Signature________________________________________ Date__________________________

Print Name______________________________________ Title___________________________

School________________________________________________________________________

California State University, San Bernardino

Computer Science, Engineering, Mathematics Scholarship
RecommendationLetter (Non-Confidential)

Name of Applicant___________________________________ SS#_____________________________

1. How long have you known the applicant and under what circumstances?
 
 
 
 
 
 
 
 
 

2. How would you rate the applicant in comparison to all other students you have known in the past three years? (e.g., the upper 5%, 10%, 25, etc.).
 
 
 
 5%, 10%, 25, etc.).
 
 
 
 
 
 
 
 
 

3. Why do you recommend the applicant for a scholarship? What qualities, personal characteristics, and interests does the applicant possess which make her/him outstanding among other students?
 
 
 
 
 
 
 
 
 
 

Signature________________________________________ Date__________________________

Print Name______________________________________ Title___________________________

School________________________________________________________________________ _______