Fillable Longwood Summer Scholars: Exploring Science (Longwood University)

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Longwood Summer Scholars: Exploring Science (Longwood University)

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Longwood Summer Scholars: Exploring Science
STUDENT APPLICATION - DEADLINE: FEBRUARY 21, 2020
PROGRAM DESCRIPTION
Longwood Summer Scholars: Exploring Science is a summer research program for high school students that
are historically underserved in the sciences, engineering, and mathematics (STEM). It is funded in part by the
American Chemical Society (ACS) Project SEED
and the Army Educational Outreach Program (AEOP)
Research & Engineering Apprenticeship Program (REAP). Students who are selected to participate in the
program will work in a research group under the direct mentorship of a Longwood University professor. The
program includes enrichment activities designed to help students prepare for college and a future career in a
STEM-related field. The program starts on March 27, 2020 and ends on July 17, 2020. Students who
successfully complete the summer research program receive a fellowship of $2,500.
HOW TO APPLY Complete steps 1 – 4 below.
1. Obtain a copy of your high school transcript.
2. Prepare a written essay (form attached).
3. Complete the Longwood Summer Scholars Application (form attached).
4. List the name and contact information of a high school science or math teacher who will act as
your reference on the application form. This person will be contacted and asked to provide a letter
or reference. NOTE: Make sure the teacher agrees to be your reference!
5. IF SELECTED to participate, a copy of the Parent/Guardian’s 2018 IRS 1040 Tax Form will be
requested from you for income verification. Finalists will be notified starting in late March.
Selected students will be notified by April 16.
a. Project SEED fellowships will be given to students whose maximum family income does not
exceed 200% of the current Federal Poverty Guidelines based on family size
(http://aspe.hhs.gov/poverty
)
b. REAP fellowships will be given to students whose maximum family income exceeds 200% of the
current Federal Poverty Guidelines based on family size but meet one of the other criteria noted
on the application.
SEND THE INFORMATION BY EMAIL or POSTAL MAIL TO:
Dr. Sarah E.G.Porter (portersg@longwood.edu)
Longwood University – Department of Chemistry & Physics
201 High Street
Farmville, Virginia 23909
QUESTIONS: Email Dr. Porter (portersg@longwood.edu) or call 434-395-2926 if you have any questions
regarding the application process or the Longwood Summer Scholars program.
CONFIDENTIALITY POLICY
All of the information that is part of the application process is confidential. Income information will be used only
for the purpose of verifying eligibility for the cash fellowship award sponsored by the ACS. The IRS 1040 form
and the Program Application form is shred and/or electronically deleted at the end of the program.
Longwood Summer Scholars: Exploring Science
STUDENT APPLICATION - DEADLINE: FEBRUARY 21, 2020
Mail or Email to:
Dr. Sarah E.G.Porter (portersg@longwood.edu)
Longwood University – Department of Chemistry & Physics
201 High Street
Farmville, Virginia 23909
STUDENT INFORMATION
(Note: Form will not be accepted if all fields are not completed.)
Student Legal Name (Last, First):
Home Address
City and state:
Zip:
Telephone Number:
Email:
Birth Date:
Grade you will enter Fall 2020
Student applicant is: (please check all that apply)
Qualified for free or reduced lunch (or family income is less than 200% of federal poverty level)*
Female
Minority (Alaskan Native, Native American, Black or African American, Hispanic, Native Hawaiian or
other Pacific Islander)
Speaking English as a second language
First-generation college student
Photo, Comments, and Completion of Follow-up Survey Release Statement:
I do certify to have my photograph and/or comments published in print or electronic promotional, marketing, or other published
works related to the Longwood Summer Scholars program and waive all rights to compensation. I, parent/guardian, also consent
and authorize my child to complete all requirements of the program. By signing this application, I agree to provide income and
family member information based on 2019 IRS 1040 Tax Form, and if selected, agree to provide a copy of 2019 IRS 1040 Tax Form.
______________________________________ ________________________________
(Student Signature) (Parent/Guardian Signature)
PARENT/GUARDIAN INFORMATION
Parent/Guardian’s
Name:
Address:
City and state:
Zip:
E-mail:
Phone:
Total Annual
Family Income: (*)
Total Number of
Family Members:
(*) this should match to the 1040 Tax Form.
HIGH SCHOOL INFORMATION
High School
Name:
Address:
City and state:
Zip:
Reference
Teacher Name:
Reference
Teacher Email:
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Longwood Summer Scholars: Exploring Science
STUDENT ESSAY
INSTRUCTIONS
Please type an essay indicating why you are interested in science, what areas of science
you are particularly interested in (e.g., chemistry, biology, physics, etc.), and what you
hope to gain from participating in the Longwood Summer Scholars: Exploring Science
Program.
ESSAY (not to exceed 1 page) – Begin typing on the next line or attach your essay.
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Completed 22 August 2020

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