First Name*

Last Name*

Middle Initial

Student Email*

Phone Number*

Date of Birth (mm/dd/yyyy)*

Student Id* If you do not have a Student ID number, you must apply for admission to Northern Virginia Community College (there is no cost to apply and no obligation to attend NOVA). The link to the online application can found at: www.apply.vccs.edu /applications/vccs/apply.html?application_id =4089

Gender*

Are you a citizen of the United States, or national of the United States as defined in section 101(a) of the Immigration and Nationality Act, or an alien admitted as refugees under section 207 of the Immigration and Nationality Act, or an alien lawfully admitted to the United States for permanent residence?

Citizen*

Ethnicity: Are you Hispanic or Latino?*

What is your race? (Select any that apply*)

Are you a Veteran of the U.S. Armed Services?*

What is the name of the high school you attend(ed)?*

What was your final or most recent term overall high school GPA? If NOVA student, your current GPA?

High School GPA*

GPA Type* NOVA GPA

Are you a first-generation college student?*
(This means that neither of your parents/legal guardians went to college.)

What math courses have you successfully completed*?

Which engineering discipline(s) are you interested in studying? Select up to three (3): Choose from the following*: Other program:

Demonstrated low-income eligibility through submission of Free Application for Federal Student Aid* --- SELECT --- (FAFSA®)Submitted (Approved) Submitted (Pending Approval) Not Submitted
(For additional information please see the following website) Eligibility Requirements | Federal Student Aid (https://studentaid.gov/understand-aid/eligibility/requirements) How to Apply (Financial Aid) - Northern Virginia Community College (nvcc.edu) (https://www.nvcc.edu/financialaid/apply/ index.html)

How did you learn about this opportunity?

Attach a copy of your high school transcript

Name and email address of a trusted adult who is not a family member and who has agreed to provide a letter of recommendation.

Recommender Email*

Recommender Name*

Relationship of recommender to student*

Write an essay based on the following directions: Please read the linked article (https://www.nsf.gov/nsb/sei/one-pagers/K-12-Indicator-2022.pdf) about STEM Education for All. In 1 - 2 pages, reflect on the reading and share your successes and challenges as a K-12 student in the areas of science, technology, engineering and/or mathematics.

Essay

Acknowledgement: By typing my name in the box below, I acknowledge that I agree to allow the scholarship selection committee to review my academic records. I also agree to allow the committee to share my application with the donor(s) of the scholarship. This will serve as my electronic signature and attest to the accuracy of my application.

Signature*

Submit