2017-2018 Honors Scholarship

Application Form

Biographical Profile:

Name:First ______Last ______MI _____

Sac State I.D. # ______Gender: [ ] Male [ ] Female Date of Birth: ______

Address ______Phone: ( ) ______

City ______State ______Zip Code ______

Daytime Phone: ( ) ______Email______

Mailing Address (if different) ______

City ______State ______Zip Code ______

Daytime Phone ______Ethnic identity (optional) ______

Applicant Certification:

I read and understood the criteria to be eligible for an Honors Program Scholarship and I wish to be considered.

I have read all the information regardingeach Honors Scholarship of interest, met all stated conditions of eligibility, and, if selected, agree to abide by the regulations stated therein. If selected as an Honors Scholarship awardee, I give the Honors Program Office and the Sacramento State Scholarship Office permission to release my name,program or college for promotional purposes.

I hereby certify that the information provided in this application is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts or circumstances that could otherwise jeopardize consideration of this application.

X ______

Type Name (Typing in your name will serve as your signature.) Date

Please indicate which scholarships you are applying for. Check the criteria for eligibility.

[ ]Edward D. Ermet Scholarship[ ]Robert S. Guardino Scholarship

[ ]Ose Family Honors Scholarship[ ]Stremple Math/Science Scholarship

[ ] Lora L. Dumont Scholarship[ ] Roberto and Gail Pomo Scholarship

Part I. Please answer the following three questions (all applicants):

1)What contributionshave you made to the Honor’s Program at Sacramento State? Or, if you are a first-year student, what contributions have you made to your high school or your local community? (250 word minimum)

2)As an Honors student, how would this scholarship allow you to pursue your academic or professional goals? (Please explain in a minimum of 500 words)

3)What changes have occurred in your academic experience since your participation as an Honors Student in the Sacramento State Honors Program? (Please explain in a minimum of 500 words. Incoming First-Year students need not answer this question.)

For specific applications, please answer the additional questions below:

  • For Ose applicants only:
  • What are your professional goals following graduation? (Please explain in a minimum of 500 words)
  • For Stremple applicants only:
  • a) What are your future aspirations in the field of math or science? What or who has led you to these aspirations? (Please explain in a minimum of 500 words)
  • b) Your Career Path – How will you benefit in the study of math or science? In other words, how is your study of math and science a part of your professional career or professional development? (Please explain in a minimum of 500 words)

Part II. Please provide the following information and documentation as an attachment to your application.

  1. List any honors or special awards that you have received. Do not abbreviate organization names. Begin with the most recent. Award/Honor Date (Month/Year) Institution/Organization
  • Award in Community Service December 2010 Associated Students, Inc.
  • Academic Award August 2011Gates Millennium Scholarship
  1. To verify courses taken in college, please provide unofficial copies of all college transcripts.
  2. Two letters of recommendation delivered to the Honors Program office is required for a complete submission. Letters can be emailed to or mailed to 6000 J Street, Sacramento, CA, 95826-6135. We suggest a letter of recommendations from the following:

A) CSUS Faculty (preferred) or Honors Faculty

B) Employer or Supervisor