National Science Foundation S-STEM
ACCESS STEM Scholarships
* indicates required items
Phone Number:
Last First
City State
E-mail address:
Date of Birth (MM/DD/YY)*:
Ridgewater Student ID# (if assigned):
Are you a* Citizen of the United States of America
Permanent Resident of the United States of America
National of the United States of America
Refugee of the United States of America
None of the Above
Providing the following demographic information is voluntary. The data may be used to create summary information for Minnesota State and to provide to the National
Foundation in summary form. Please review the following criteria carefully and check any item that applies to you:
Gender: Female Male Unlisted Prefer not to answer
Are You Hispanic or Latino? Yes No
Ethnicity: American Indian or Alaska Native Black or African American Asian
Native Hawaiian or Other Pacific Islander White or Caucasian
Select the institution(s) you wish to attend as part of this scholarship program. It should be noted that these institutions are the only ones
participating in this scholarship program.*
St. Cloud State University Anoka-Ramsey Community College
Ridgewater College St. Cloud Technical and Community College
Are you currently admitted for Fall 2019 to the institutions you checked above? If you are not yet admitted, make sure you complete
an admission application to that institution.*
Yes No Two or more of them
Are you planning to be a full time student (12 or more credits per semester)?*
Yes No
Are you Pell Grant Eligible as determined by the results of your FAFSA?*
Yes No
Are you a declared as a STEM (Science, Technology, Engineering and Math) major or in a STEM degree pathway?*
Yes No
Are you a first generation college student? (You are a first generation college student if neither of your parents received any postsecondary
Yes No
Program of Study at SCSU: Please note that pre-health professions and education professions are not eligible for the scholarship.*
Biochemistry and Molecular Biology Environmental Science
Biology Hydrology
Biomedical Sciences Manufacturing Engineering
Chemistry Manufacturing Engineering Technology
Computer Engineering Mathematics
Computer Science Mechanical Engineering
Cybersecurity Meteorology
Earth Science Physics
Ecology and Field Biology Software Engineering
Electrical Engineering Statistics
Provide any of the scores that you have a record of
Unweighted Current High School Cumulative GPA:
STEM (Science, Technology, Engineering, and Mathematics) Related Course High School
Class Rank Percentage (if available):
ACT or SAT Composite Score:
ACT or SAT Math Subscore:
Accuplacer College Level Math Score:
Accuplacer Intermdicate Algebra Test Score:
Accuplacer Elementary Algebra Test Score:
MCA Math Test Score
Degrees, Diplomas, or Certificates including date of completion:
Are you working? If yes, where?
Number of hours/week:
Once your completed application is reviewed, you may be contacted to schedule an interview as the final application step. Please indicate if
you prefer to be contacted by email or by phone to arrange this interview. We will use the phone number or email address you entered earlier
on the form.*
Email Phone
Acknowledge your acceptance of the statements below by entering your initials on the indicated line.*
The information contained within this application is true to the best of my knowledge. I understand that misrepresentation or fraudulent
information may be grounds for loss of scholarship funds and/or required repayment.
Furthermore, if named a recipient, I authorize St. Cloud State University to release any non-private information listed in this application to
the National Science Foundation and for purposes of publicizing scholarship recipients and the National Science Foundation grant.
By signing this application, I authorize the ACCESS STEM Review Committee to access my transcripts and financial aid information to
confirm my eligibility for the ACCESS STEM Scholarship.
I understand that if selected for a scholarship, I will have to provide documentation proving that I am a citizen, national, or permanent
resident of the United States of America, or admitted to the United States of America as a refugee.
If I am a scholarship recipient, I understand that I must participate in scholar activities associated with the scholarship, including seminar and
research courses, field trips, tutoring, and other activities as prescribed by the scholarship committee. I also understand that I may be required
to complete particular courses or enroll in a specific section of a course. (It should be noted that the purpose of the scholarship is to insure the
success of the scholarship participants. Activities are designed to help students in their classes and progress towards their degree. If a student
has a concern with the requirements of the scholarship, they should feel free to discuss the issue with an ACCESS STEM Faculty advisor at
their institution.)
Official Use Only
Financial Aid Information EFC: Comments:
Aid File Complete: Yes No Date Completed Other
Only complete applications will be reviewed, please check that each item in the following list is included before submitting your
1. A complete and legible scholarship application form.*
2. Write an essay describing your academic and career goals. Describe how you intend to accomplish your goal, and describe
at least one past experience where you overcame an obstacle to achieve a goal and how that experience will help you
accomplish your future goals. Your essay should be roughly 500 words. It should be typed and included with your
3. Two letters of recommendation from previous teachers or school counselors. At least one from a High School STEM
4. Transcripts of all high school and college level coursework at all institutions. Please be sure to include any AP, PSEO, or
S2S coursework transcripts for STEM as these are given highest consideration.*
5. Documented participation in summer pipeline or bridge programs such as SDP/APTS or TRIO Upward Bound (if you
have participated in a bridge program).
6. Additionally, you must have completed and have the results of your Free Application for Federal Student Aid (FAFSA).
The results must be transmitted to the institution of your choice.*
Incomplete applications will NOT be reviewed. It is your responsibility to ensure that your file is complete.
Applicant’s Signature:* Date:*
A contact who can reach you (other than yourself):*
Relationship:* Phone number:
City, State, Zip:*
E-mail (if available):
We will use the above contact information only if we are unable to contact you through other means. We will not discuss
application or scholarship information with the above contact.
Please submit your complete application package by the application deadline to:
Dawn Bjork-Pedersen
Ridgewater College
2101 15th Ave NW
Willmar MN 56201
For questions, please contact
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