Gene Haas Foundation Scholarship Application

I, NAME have read and understand the conditions of the Upstart-GENE HAAS Foundation Scholarship as explained in the Notes to Candidates for Scholarships. I affirm that I plan to pursue a career that would benefit from knowledge learned in CAD/CAM, CNC, METROLOGY or GD&T classes as defined in the Notes to Candidates. I give permission to officials of my institution to release transcripts of my academic record, and other information requested, for consideration by the Upstart-GENE HAAS Foundation.I understand that this application will be available only to qualified people who need to see it in the course of their duties. I waive the right to access letters of recommendation written on my behalf. I affirm that the content of this application, including the policy proposal, is my own work or formally cited from other sources. I affirm the information contained herein is true and accurate to the best of my knowledge and belief.

Date*

Date

Signature*

Name*

Legal name in full (Print/Type)Last Name

Permanent Residence (Number, Street and Apartment Number)*

City*

State*

Zip Code*

How is permanent residence established? (at least two must apply and be provided)*

Home address for school registrationPlace of registration to voteFamily's primary residenceOther

Home telephone

Please enter a valid phone number.

Cell phone (if different)

Please enter a valid phone number.

Email address*

example@example.com

Date of birth*

Date

Age*

(Check One) I am:*

U.S. CitizenU.S. NationalResident alien expecting citizenship by date of award

Name of High School attending:*

Current cumulative GPA:*

On a scale of:*

Name of Community College attending:

Current GPA:

On a scale of:

List your extracurriculars:

Expected date of graduation*

Date

Which Community College will you be attending?*

Which class are you applying for ?*

1. List the secondary school from which you graduated, and all higher education institutions attended (include summer or alternative schooling). Please include the school name(s), location(s) and dates attended.*

2. List college and high school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, music, etc. List in descending order of significance. Please include dates.*

List High School Activities

List College Activities:

3. List public service and community activities (homeless services, environmental protection/conservation, advocacy activities, work with religious organizations, etc.). Do not repeat items listed previously. List in descending order of significance. Please include the activity, role, and number of weeks active.*

4. List part-time and full-time jobs while in high school and after graduation. Please include the type of work, employer, dates worked, and average number of hours worked per week.*

5. List awards, scholarships, publications and special recognitions you have received. List in descending order of significance.*

6. Describe one specific example of your leadership.*

7. Describe a recent particularly satisfying public service activity (do not repeat experience described in 7).*

8. Describe the problem or needs of society you want to address when you enter public service. (If possible, use statistical data to define the magnitude of the problem.)*

9. What are the three most significant courses you have taken in preparation for your future?*

10. Describe the graduate education program you intend to pursue if you receive an Upstart Gene Haas Foundation Scholarship.*

11. What do you hope to do, and what position do you hope to have, upon completing your graduate studies?*

12. What do you hope to do, and what position do you hope to have, five to seven years later?*

13.What additional personal information do you wish to share with Resilient and the Upstart Gene Haas Foundation?*

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