Sandford “Sandy” Liebesman Scholarship Application

Please PRINT or TYPE

First NameMiddle InitialLast Name
Address
CityState/ProvinceZip/Postal CodeCountry
Telephone Number / E-mail

Education

Name / Location / Date of Graduation
High School
Name / Location / Expected Date of Graduation
College
Grad School
Major

Please provide:

1)A letter of acceptance for the upcoming Fall semester or, if currently enrolled, a letter of good standing from an accredited college or university.

2)The most recent transcript of the applicant's academic record. The transcript must be signed by the school’s principal/dean, guidance counselor, registrar or an authorized alternate.

3)Please attach a listing of:

a)Extracurricular activities.

b)Honors and awards.

c)Optional: other relevant information regarding the applicant’s character, leadership, community service, etc.

4)An original essay, written by the applicant, of not less than 750 words on “How have the quality and reliability of electronics and communications affected your life and how do you expect it to affect your future especially with regards to education?”

©ASQ, 2013, Scholarship Application, draft rev 0Page 1

Sponsor’s relationship to Applicant (check one):

Self

Related. Specify family relationship:

Examples of relatives include: spouse, children, step children, grandchildren, niece, nephew, siblings, etc.

Other (i.e. friend, neighbor, etc.). Specify relationship:

Are you a previous recipient of the ASQ Electronics & Communications Division Scholarship?NOYES

If YES, when?

Applicants must be sponsored by a member of the Electronics & Communications Division. Members may sponsor themselves. The applicant’s signature is acceptance and agreement of the Copyright Assignment and License Back.

Signature of Applicant: / Date
Signature of Sponsor: / Date
Sponsor’s Name (Please Print): / Sponsor’s ASQ Membership Number

Copyright Assignment and License Back

In consideration of the opportunity, to compete for the ASQ Electronics Communications Division Sandford “Sandy” Liebesman Scholarship, and the mutual covenants contained herein, the American Society for Quality (“ASQ”) and the individual applicant identified elsewhere in the application (“Applicant”), agree as follows:

  1. Assignment. Applicant hereby transfers to ASQ all copyright interests worldwide in the quality-related essay accompanying this application (the “Work”), including without limitation all of the exclusive rights listed in 17 U.S.C. §106, and any causes of action for infringement of the Work that may have accrued prior to the effective date of this Agreement.
  2. License Back. ASQ grants to Applicant a limited, royalty-free, nonexclusive and nontransferable license to revise, reproduce, present or distribute the Work, but only for scholarly and noncommercial purposes. If the Applicant wishes to make any commercial use of the Work, or any other work containing or based on the Work, prior express written permission must be obtained from ASQ.
  3. Ownership. Applicant hereby represents and warrants that the Applicant: (i) is the sole author of the Work, (ii) is the owner of all rights, title, and copyright interest in and to the Work, (iii) has the right and ability to perform fully under the terms of this Agreement, and (iv) has not executed, nor will execute, any assignments, licenses, grants of security interests, or other agreements that would limit in any way the effectiveness of the transfer described above.
  4. Infringement and Indemnification. Applicant hereby represents that the Work does not infringe, violate or misappropriate any proprietary rights or properties of any third parties, and agrees to indemnify and hold harmless ASQ from any and all damages and costs, including reasonable attorney’s fees, resulting from any claims of such infringement, violation or misappropriation.

Sandford “Sandy” Liebesman Scholarship

Submission Checklist

Please use this checklist to ensure that you are submitting everything required.

____ /
  1. The applicant will be attending an accredited college or university the Fall semester immediately following the submission deadline.

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  1. Both pages of a completed Sandford “Sandy” LiebesmanScholarshipApplication.

____ /
  1. The applicant is sponsored by a member of the Electronics & Communications Division.

____ /
  1. A letter of acceptance for the upcoming Fall semester or a letter of good standing (if currently enrolled) from anaccredited college or university.

____ /
  1. The most recent transcript of the applicant's academic record.

____ /
  1. The transcript is signed by the school’s principal/dean, guidance counselor, registrar or an authorized alternate.

____ /
  1. A listing of the following:
a)extracurricular activities
b)honors and awards
c)Optional: other relevant information regarding the applicant’s character, leadership, community service, etc.
____ /
  1. An original essay, written by the applicant, of not less than 750 words on “How have the quality and reliability of electronics and communications affected your life and how do you expect it to affect your future especially with regards to education?”

Applications and attachments need to be submitted to:Jim Spichiger

Scholarship CommitteeChair

ASQ Electronics & Communications Division

109 Drogheda Ct

Granville, OH 43023

Sandford “Sandy” Liebesman Scholarship

Eligibility Requirements

  1. The applicant must be sponsored by a member of the Electronics & Communications Division. Division members may sponsor themselves.
  1. No one will be disqualified from consideration because of sex, race, color, creed, or religious beliefs.
  2. Professionals receiving full tuition reimbursement from their employer are not eligible.
  3. The applicant must have been accepted and will attend an accredited college or university the Fall semester immediately following the submission deadline. Applicants would include but are not limited to: a graduating high school student, an undergraduate or graduate college student already enrolled in an accredited college or university, a professionalenrolling part-time in college or graduate school, etc.

Application Submission

  1. The completed application and the other items listed below must be received by the Chair of the Electronics & Communications Division’s Scholarship Committeeon or before February 15.
  2. The scholarship submission must include the following:

a)A completed Electronics & Communications Division’s ScholarshipApplication. Applications are available to all members of the Electronics & Communications Division.

b)A letter of acceptance for the upcoming Fall semester or, if currently enrolled, a letter of good standing from anaccredited college or university.

c)The most recent transcript of the applicant's academic record. The transcript must be signed by the school’s principal/dean, guidance counselor, registrar or an authorized alternate.

d)A listing of: extracurricular activities and honors awards. Other relevant information regarding the applicant’s character, leadership, community service, etc., may also be provided.

e)An original essay, written by the applicant, of not less than 750 words on “How have the quality and reliability of electronics and communications affected your life and how do you expect it to affect your future especially with regards to education?”

Award Selection

  1. Selection of recipient(s) will be made by the Electronics & Communications Division’s Sandford “Sandy” Liebesman Scholarship Committee within 90 days of the application due date.
  2. Alternates may be selected from among the finalists in the event the recipient(s) does not accept the award.
  3. The following factors (not in any order of priority) will be taken into consideration during the selection process:

a)Academic achievements.

b)Extracurricular activities.

c)Honors and awards.

d)The 750 word essay.

e)Relationship to the sponsor. Note: Electronics & Communications Division members have an advantage over relatives of members and other applicants. Relatives of division members have an advantage over other applicants.

f)Previous recipients of the scholarship. Note: previous recipients are at a distinct disadvantage.

Award Issuance

  1. Scholarship recipient(s) will receive payment of the full or partial scholarship award as determined by the Electronics Communications Division’s Sandford “Sandy” Liebesman Scholarship Committee.
  1. The award is of a monetary nature to be used by the recipient in any manner to defray the costs associated with college expenses. Note: Recipients are required to provide proof (i.e. receipts) that the scholarship award was used for the intended purpose.
  1. Recipients are solely responsible for any tax liabilities incurred.
  2. Applicants are free to select any matriculated course in an accredited college or university. The entire process of applying for admission to college is solely the responsibility of the applicant.
  1. Award acceptance does not prohibit recipients from receiving other scholarships.

©ASQ, 2016Sandford “Sandy” Liebesman Scholarship Application, rev 2Page 1