Instructions: Please Type Or Neatly Print. Submit All Application Materials to Robert Noyce

Instructions: Please type or neatly print. Submit all application materials to Robert Noyce STEM Scholars Program, FLC 314
Deadline for receipt of all applications and supporting materials: November 1, 2010.

Name: ______Today’s date:______
Last First Middle Initial

Local address: ______

______

Local telephone: ______E-mail: ______

Permanent address: ______
______

Telephone at permanent address: ______

Student ID #: ______

Place of birth: ______
City State/Province Country
Date of birth: ______
National Science Foundation requirements stipulate that Robert Noyce STEM Scholar recipients either be U.S. citizens or permanent residents of the U.S. Please indicate your status: U.S. citizen [ ]Permanent U.S. resident [ ]

Gender: Female [ ] Male [ ]

Check any that apply:
American Indian [ ] Hispanic [ ] African-American [ ] Other Minority:______

Level at NDSU beginning spring 09: Junior [ ] Senior [ ] Post-Bac [ ]

Department or program name(s): ______

Name, City, State of High School you attended: ______

Are you currently admitted to the School of Education? ______

Current NDSU GPA: ______
(Please attach a copy of your grade report or unofficial transcript)

Academic distinctions or honors earned: ______

______

Teaching and Research experience (if applicable): ______

______

Interest Statement: On a separate page, write a statement (not more than one page) explaining
your career objective and why you are interested in participating in the Robert Noyce Scholars program (beyond financial support).

Financial Need: Provide a statement (not more than one page) as to the impact of this forgivable-loan program would support your studies.

References: You need to arrange for at least two letters on your behalf to arrive at the Center for Science and Mathematics office no later than the deadline. These letters should include faculty, supervisors, or professionals with whom you have studied. Please provide to each reference one copy of the Reference Form (see Noyce “Forms” page).

Referee #1: ______
(Name) (Department or affiliation)

Referee #2: ______
(Name) (Department or affiliation)

Referee #3: ______
(optional) (Name) (Department or affiliation)

By my signature below, I hereby commit my application to the Robert Noyce STEM Scholars.
______
(Signature) (Date)

Checklist of Application Materials:

_____ Signed application form

_____ Grade report or unofficial transcript

_____ Statement of interest in Noyce program

_____ Statement of financial need

_____ Arranged for reference letters from at least two referee to arrive by November 1, 2010, deadline (information forms provided to each referee)

Please submit all of your application materials by November 1, 2010, to:

Robert Noyce STEM Scholars Program

FLC 314

North Dakota State University

Fargo, ND 58108-6050

The review process of applications will begin immediately after November 1, 2010. You will be notified of your status by Thanksgiving time.