Scholarship Application

Are you a member of the Booth Honors Program? *

Yes

No

(if you selected no, then you are not eligible to apply)

Personal Information

First Name *

Last Name *

Digital ID *

Phone Number *

Year in School *

I am enrolled in at least 12 credits this semester *

Yes

No

I have a cumulative GPA greater than 3.5 *

Yes

No

Scholarship Requested *

Study Abroad

Conference Travel

Research, Innovation, and Creative Projects

Program Details

Program Title *

Example: Natural History of Costa Rica

Course Number

Example: ENVS 3910

Faculty/Contact's Name *

Program Fee Information

Estimated Program Fee *

Amount Requested *

Not to exceed $1500

Refund Policy

Program Fee Covers *

Program Fee Does Not Cover *

Tentative Dates

Travel Start Date *

Travel End Date *

Class Dates *

Example: Spring 2018 or May 8-10th

Payment Schedule Dates *

Example: Deposit due Monday, December 4, 2017 or Fee attached to DSU Tuition

Rationale for Participation

Tell us about the program you want to participate in. *

Explain the financial need you have and how the scholarship will help. *

Tell us about any other scholarships or grants you have applied for.

Please share other experiences or opportunities you've had that are similar to this opportunity. *

Why would you like to participate in the program? *

How does this experience help reinforce your educational and career goals? *

Conference Details

Conference Name *

Location *

Start Date *

End Date *

Conference Fee

Amount Requested

Reason for funding request

Tell us about any other scholarships or grants you have applied for.

Project Details

Type of Project *

Poster

Presentation

Panel

OtherOther

Project Title *

Description of the Project – What are you wanting to present on? (this could be your abstract) *

Mentor Information

Mentor First Name

Mentor Last Name

Mentor Email

Only current UT faculty (professors) may serve as mentor

Project Information

Title of Research, Innovation, or Creative Project

Provide a summary of your proposed project

0 of 500 max words

Summary should include (1) a brief background, (2) goal(s) of the project, (3) method(s) to be used in this project, and (4) expected outcome(s). 500-word limit.

How does this project benefit YOUR education and future goals?

0 of 250 max words

250 word limit

Budget Information

All requested funds must be applied directly to the applicant student’s research. Awards are limited to $500.

rovide a detailed itemized budget. This must include the name of the item(s) to be purchased, the number of items, the cost per item, and the name of the retailer where the item will be purchased.

If budget will support other expenses, such as interviews or participation fees, please provide a brief explanation of how that funding will be used.

Please list other funding sources you have approached to fund your project. How will you pay for costs not covered by this grant?

Students are encouraged to apply to at least one other funding source.

Applicant's Signature *