P.O. Box 1166Bettendorf, IA 52722http://www.qcesc.org

QUAD CITY ENGINEERING AND SCIENCE COUNCIL2017 APPLICATION FOR SCHOLARSHIP

APPLICANT:      ADDRESS:      

TELEPHONE:      EMAIL CONTACT:       Gender:

PLEASE MAIL COMPLETED APPLICATION; POSTMARKED BY JANUARY 24, 2017 QCESC

Attn: Scholarship CommitteeP.O. Box 1166

Bettendorf, IA 52722

Requirements for Eligibility1. Must be a high school senior. Also must be a resident of Mercer, Rock Island, Henry, Whiteside,

Carroll, Knox, Lee, Clinton, Scott, Muscatine, or Louisa County. 2. Must plan to study STEM related degree (Science,Technology,Engineering or Mathematics) at an

accredited four-year college or university. For definition of stem degrees see page 7

Description of ScholarshipThe Quad City and Engineering Science Council Scholarship Program was established and is administered by the Council. This program provides multiple one-time grants/scholarships between $1000 and $3000 each. These are awarded on an objective basis without regard to race, sex, or religion. Criteria include academics, civic/community service, extracurricular involvement, career goals, and an essay on why you want a STEM degree. Funds from this grant must be applied to tuition or fees related to eligibility item 2. Additionally, scholarships from several Engineering Colleges may be available via this form. (see page 6)

Award PresentationScholarships awards will be presented at the Annual Engineers Week Banquet on, or about February 23, 2017. The scholarship winners will be the guests of the QCESC at the annual awards dinner. Family members are encouraged to attend at the regular meal price; contact Tom Hein for details. Winners will be requested to provide a photo for publication with the award announcement in the QC local newspapers and on the QCESC website. Contact information may be shared with our member organizations for the opportunity of additional scholarships.Imortant Note:This form can be completed and printed for mailing as a MS Word Document (DOC) from the QCESC website at www.qcesc.org, under QCESC Information (scholarships). An Adobe Acrobat (PDF) file is also available for printing copies to fill out by hand or typing (typing is recommended). For additional information or assistance, contact Tom Hein at mailto:TKHein@gmail.com or Telephone (309)-798-0556.

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 2

EMPLOYMENT:

Are you presently employed? Yes No

Hours per

week >15 5-15 <5 Summer

Paid Volunteer If yes, name of employer Phone ( )

Type of work performed

HIGH SCHOOL INFORMATION:The information requested must be completed and verified by a representative of your school.

ACT Composite Score High School Senior Grade Point Average

High School Senior Class Rank Number in Class

High School Name Expected Date of Graduation

Signature of High School Representative Title

Please attach Transcript

COLLEGE INFORMATION:

Name of four year schools you plan to attend and their location

Course of Study Major Minor

If you want to be considered for a university sponsered scholaraship, check and rank your choices – see page 6 for details. To receive the scholarships, you must apply and be accepted into their College of Engineering

Iowa State University

University of Iowa

University of Illinois - Chicago

University of Wisconsin - Platteville

Western Illinos University Quad Cities

St.Ambrose University

# # # # # #

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 3

OTHER INFORMATION:1. List extra-curricular activities you have participated in during the past three years or are now

participating in and the offices held:

     

2. List any achievements, special awards, etc., you have accomplished or received during the past three years:

     

STEM ActivitiesProject Lead the Way Yes No FLL Yes No FTC Yes No FRC Yes No Others?

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 43. List any community related activities you have participated in during the past three years

     

     

4. State briefly your career goals and how you plan to accomplish them:

     

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 55. In the space provided, explain why you would like to obtain a degree in Engineering or Science.

This essay is often the key differentiator for selection. Please type or write very neatly.

     

I (we) certify that all answers to the preceding questions are true and correct. I (we) understand that any false answers or deliberate omissions on this application may be grounds for rejection of this application and withdrawal of any award granted. I (we) authorize investigation of the applicant’s employment, schooling, and other activities and release those persons, organizations, or companies supplying information from all liability and responsibility for any damages I (we) may suffer as a result of this information. I (we) agree that I (we) will abide by all decisions made by the Quad City Engineering and Science Council.

Applicant’s Signature Date      

Parent or Guardian Signature (if applicant is a minor; if applicant is over 18, then write N/A in this box).

Date      

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 6

Additional Scholarship InformationFor the 9th consecutive year, in addition to scholarships from the QCESC and its member societies, scholarships will also available from the following Engineering Colleges:

Iowa State University (2 x $1,000 scholarships) University of Iowa (2 x $1,000 scholarship) University of Illinois – Chicago (1 x $1,000 scholarship) University of Wisconsin – Platteville (1 x $2,500 scholarship) Western Illinois University – Quad Cities Campus (10 x $13,000, 5

x $42,000) over 4 years St. Ambrose University (1 x $2,000)

To be considered for one of these scholarships in addition to the QCESC scholarships, please indicate your interest in the “SCHOOL INFORMATION” box on page 2 of this application. These scholarships are administered directly by the College of Engineering at these Universities; the QCESC selects and recommends applicants to the colleges. To receive the scholarships, you must apply and be accepted into their College of Engineering.

Additional Requirements for University of Iowa and Iowa State University: Applicants are preferred to have participated in PLTW and robotics

Contact Tom Hein (see contact information on page 1) for more information and availability of these scholarships.

QUAD CITY ENGINEERING AND SCIENCE COUNCIL SCHOLARSHIP APPLICATION PAGE 7STEM Related DegreesAn exhaustive list of STEM disciplines does not exist, but the U.S. Immigration and Customs Enforcement STEM Dergree List  includes this subset:[

Physics

Actuarial Science

Chemistry

Mathematics

Statistics

Computer Science

Psychology

Biochemistry

Robotics

Computer Engineering

Electrical Engineering

Mechanical Engineering

Industrial Engineering

Civil Engineering

Aerospace Engineering

Chemical Engineering

Astrophysics

Astronomy

Nanotechnology

Nuclear Physics

Mathematical Biology

Operations Research

Neurobiology

Biomechanics

Bioinformatics

Acoustical Engineering

Geographic Information Systems

Atmospheric Sciences

The National Science Foundation is the only American federal agency whose mission includes support for all fields of fundamental science and engineering, except for medical sciences.[7] It lists its disciplinary program areas as:

Biological Sciences

Computer & Information Science & Engineering

Education and Human Resources

Engineering

Environmental Research & Education

Geosciences

International Science & Engineering

Mathematical & Physical Sciences

Social, Behavioral & Economic Sciences

Cyberinfrastructure

Polar Programs