MORTAR BOARD

National College Senior Honor Society

Agathai Chapter at the University of California, Los Angeles

Application for Mortar Board Scholarship

FOR ACADEMIC YEAR 2015-2016

More information about Mortar Board’s scholarship program can be found at

Section 1. Completed Application and Deadline

The Agathai chapter of Mortar Board at UCLA invites applications for Mortar Board scholarships and endeavors to provide for a streamlined, yet thought-provoking application process that allows each applicant to showcase her/his accomplishments and plans in academics and post-graduate life. The scholarship selection process is managed by Mortar Board’s Scholarship Committee, which reviews all completed applications.

  • One $500 scholarship will be awarded to a transfer student.
  • One $500 scholarship will be awarded to an underclassman at UCLA (1st year or 2nd year).

A completed application for a Mortar Board Scholarship consists of two parts:

  1. This application form, completed in full (8 sections total), and sent as an e-mail attachment .
  2. A current, unofficial transcript that includes your cumulative grade point average (GPA).

The deadline for the completed applicationis April 4, 2016 (Monday of Week 2). An incomplete application will receive no consideration. Please also keep in mind that if you receive the award, your presence will be requested at our award ceremony in Spring Quarter.

Section 2. Suggestions and Mortar Board Contact Information

Thorough, precise and legible information on the application form will enhance the Scholarship Committee’s ability to consider your application. Accurate spelling and correct grammar and punctuation used in conjunction with well-reasoned and thoughtful essay answers are baseline expectations of the committee. Read the application completely before you start formulating your responses. Save your work to your own file storage as you complete this Word document.
Take your time and plan ahead to ensure that both parts of the application are received by Mortar Board on or before the deadline. You are responsible for the completion of the two parts of the application. Although Mortar Board’s Scholarship Committee will not initiate calls or e-mails to you to notify you about the status of your application, you are welcome to e-mail Mortar Board to confirm the receipt of your completed application.
Mortar Board’s mailing address is UCLA Center for Student Programming (105 Kerckhoff Hall), 308 Westwood Plaza, Los Angeles, CA, 90024. Please attention all correspondence to Pamela Cysner.
E-mail: .

Section 3. Contact Information

Full Name
Street Address
City, State, Zip
Primary E-mail
Primary Phone

Section 4. Academic Recognition and Awards

List significant academic awards and honors received at your current and/or past academic institutions. Include all scholarships, publications, recitals, study abroad, etc.

Section 5. Leadership

List the major leadership contributions that you have made through extra-curricular and community activities. You may certainly list the title of your formal position with an organization. Note that the scholarship selection committee is most interested in a concise description of the contribution you made while you held the position.
Activity / Description of your contribution / Time Contributed / Month & Year Started / Month & Year Ended
(limit 50 words each) / (hours per week)

Section 6. Community Service and Extracurricular Activities

List your community service and extracurricular activities. Include clubs, employment, etc., and any relevant positions held.
Activity / Description of your involvement / Time Contributed / Month & Year Started / Month & Year Ended
(limit 30 words each) / (hours per week)

Section 7 Personal Statement

Describe your professional and personal goals and how a college degree will help you achieve them. What does higher education mean for you? In addition, please explain how you show a commitment to scholarship, leadership, and service in your life right now.
(Limit 500 words)

Section 8. Certification

By my signature below, I acknowledge that I am solely responsible for ensuring that my application is completed by the deadline, pursuant to Section 1 above. Further, I certify that all information in my application is accurate.

Signature * Date signed
*If submitting this form electronically, in lieu of your signature, you may indicate that
you agree with the certification statement above by typing your first initial and last name in this box: