ACPA Undergraduate Scholarship in Chemistry Application

ACPA Undergraduate Scholarship in Chemistry Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Enrolled Since (Date)*
Institution*
Degree Sought*
Ph.D*

YesNo
Institution Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload an official transcript that includes the grades of the most recent eight chemistry courses completed and that indicates your registration in a CSC-Accredited chemistry program at a university in the province of Alberta.*

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A letter of 100 to 200 words that describes the applicant's contributions to the chemical profession through volunteer activities and details of the membership in any chemistry related organizations (such as the ACPA, the CIC, and chemistry student societies).
Upload letter here.*

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The names and contact information of two individuals who collectively can verify all information provided in the letter.
Reference #1 Name*

First NameLast Name
Reference #1 Email*
example@example.com
Reference #1 Phone Number*
Please enter a valid phone number.
Reference #2 Name*

First NameLast Name
Reference #2 Email*
example@example.com
Reference #2 Phone Number*
Please enter a valid phone number.
Upload copies of certificates, diplomas, awards, reference letters or other documents that substantiate the activities described in the letter (if available).

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I hereby declare that the information provided in this application and its attachments is a true and accurate description of my activities and achievements.*

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Date*

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