Fillable APPLICATION FORM Computer Science, Mathematics, and Physics Scholarship (Central Connecticut State University)

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APPLICATION FORM Computer Science, Mathematics, and Physics Scholarship (Central Connecticut State University)

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Computer Science, Mathematics, and Physics
Scholarship Program of Central Connecticut
Central Connecticut State University
Manchester Community College
Tunxis Community College
APPLICATION FORM
Please refer to the program website at
https://www.ccsu.edu/csmp/application.html for current application due dates
Name: _________________________________________________________________________
Last, First Middle
Email address: _________________________________________________________________
Mailing address: ________________________________________________________________
Street address
___________________________________, ____________ _______________
City State Zip Code
T
elephone number: ____________________________________
Currently a student at: ____________________________________________________
High school, college, or university
Major: _________________________________________________________________
Intended or current major/program at CCSU / MCC / TCC
Current GPA (on a 4.0 scale): ________________ Combined SAT Score*: ___________
Current level (check only one):
High school:
Senior
College:
Freshman Sophomore Junior Senior
Gender**:
Female Male
R
ace** (check one or more):
African American Asian American
American Indian Hispanic
White Other (please specify) _____________
*
Required only for CCSU applicants
** This information is optional and will not be used as selection criteria
Ap
plicant’s signature: ________________________________________
Date: _____________________________________________________
click to sign
signature
click to edit
Additional Information
The following required application materials must be received no later than the application
deadline listed at https://www.ccsu.edu/csmp/application.html:
• C
ompleted application form (this form);
• Personal essay (one page): explain your academic and career plans, provide your reasons
for majoring in one of CSMP disciplines, describe your background and experience in science
and mathematics;
• High school and/or college transcript;
• Two or more letters of recommendation (preferably from your instructors);
• Evidence of citizenship or immigration status (you must be a US citizen or permanent
resident to be eligible for this program). Acceptable documents include a copy of birth
certificate or passport for US citizens, or a copy of the green card for permanent residents.
A
ll application materials must be sent by email to the corresponding campus contact
listed below.
A
ll applicants must have a demonstrated financial need and have a completed FAFSA application
form by the time of applying for this scholarship.
Incoming freshmen and transfer students must have application for admission to CCSU/MCC/TCC by
the time of applying for this scholarship.
F
or more information about the scholarship program please refer to our web site at
http://www.ccsu.edu/csmp
.
Specific application and eligibility requirements are described at
http://www.ccsu.edu/csmp/requirements.html
Contact Information
CCSU applicants
D
r. Stan Kurkovsky
Program Director/CCSU
k
urkovsky@ccsu.edu
(860) 832-2720
MCC applicants
M
s. Ibtsam Mahfouz
Program Coordinator/MCC
I
Mahfouz@manchestercc.edu
860-512-2710
TCC applicants
D
r. Karen Birch
Program Coordinator/TCC
k
wosczyna-birch@commnet.edu
860-723-0075
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APPLICATION FORM Computer Science, Mathematics, and Physics Scholarship (Central Connecticut State University)

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Completed 1 June 2022

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