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To ensure the timely processing of your form, please enter all of the necessary information. |
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| * Select your program |
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| * First Name |
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| Middle Initial |
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| * Last Name |
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| Student ID # (mandatory for returning BSC students) |
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| * Phone (xxx-xxx-xxxx) |
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| * Preferred Email Address |
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| * Permanent Address |
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| * City, State, Zip |
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| * Address while attending BSC |
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| * City, State, Zip |
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| * Have you filed a FAFSA form with the Bismarck State College financial aid office? |
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| * All scholarship recipients must enroll in at least 6 or more credits per semester to be eligible to receive funding. Please choose your current enrollment status: |
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| Gender (optional) |
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| Ethnicity (optional) |
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| Disability (optional) |
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| Please provide the following scores, if you have completed them (High School GPA) |
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| Please provide the following scores, if you have completed them (Composite ACT Score) |
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| * Year of Graduation |
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If you have completed the COMPASS, ACCUPLACER, etc., please provide English scores:
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| If you have completed the COMPASS, ACCUPLACER, etc., please provide Math scores: |
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| If you have completed the COMPASS, ACCUPLACER, etc., please provide Reading scores: |
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| If you did not graduate, did you receive a G.E.D.? |
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| Date G.E.D. was received |
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| * Why did you choose your major field of study? |
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| * What are your future educational and career plans? |
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| * Is there anything else you would like us to know about you and your application that we should consider? |
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| * I certify that the information I have provided here is accurate. I give the BSC Student Service Offices permission to release my name, address, telephone number, GPA, and other scores to share with the AIM scholarship selection committee. I also give permission to BSC to use information about my academic progress, major, participation in STEM activities, transfer institution, and choice of major for publications and presentations related to this project. My name will not appear on any data reported to the National Science Foundation.
APPLICANT'S SIGNATURE OR BY TYPING YOUR NAME HERE, YOU AGREE TO THE STATEMENT ABOVE |
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| * SIGNATURE DATE |
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