Application Form for
Scholarships in Science, Technology, Engineering, and Mathematics (S-STEM)
at University of Hawaiʻi at Hilo
PLEASE USE FILLABLE FIELDS OR, IF FILING IN HARD COPY, PRINT CLEARLY WITH BLUE OR BLACK INK.
Last Name First Middle
Street Address Gender
City State ZIP
Phone E-mail Address
High school you attend Grade
High school GPA When do you expect to graduate? (Month and year)
Which science or mathematics program at UH Hilo is your desired major?*
Are you a citizen or permanent resident of the United States?
Accepted documentation: Passport, Birth Certificate, Proof of
Permanent Residence (“Green Card”).
YES
M
)
NO Have you applied to UH Hilo? (If Yes,
provide a copy of your application.)
YES
NO
Which of your parents has a Bachelor’s degree?
(First generation students are encouraged to apply.)
Neither
other Father Both
Have you filed the Free
Application for Federal Student
Aid (FAFSA)?
YES NO Are you eligible for PELL Grant?
YES
NO
Ethnicity (check all that apply below
America Indian Alaska Native Native Hawaiian Other Pacific Islander
Asian Hispanic B
lack or African American White Filipino
Other (please specify at right)
Please provide an official High School transcript from each High School you have attended, an official copy of your SAT scores or ACT scores with
completed writing part, and a list of Mathematics courses you have completed or are in process of completing, with your grades in each (most recent
report accepted).
The S-STEM program, in accordance with the Americans with Disabilities Act, is committed to a policy of nondiscrimination on the basis of disability.
REFERENCES: PLEASE USE FILLABLE FIELDS OR, IF FILING IN HARD COPY, PRINT CLEARLY WITH BLUE OR BLACK INK.
Please list two professional references, such as a math and/or science teachers.
Full Name
Institution
Address
Relationship
Phone
Email
Full Name
Institution
Address
Relationship
Phone
Email
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
Signature Date
See next page for your required Personal Statement.
Remember to have your letter of recommendation sent directly by your teacher. See Application Checklist for specific
instructions regarding this requirement for your application.
*Majors offered at UH Hilo that are eligible for S-STEM Scholarship include: Astronomy, Biology, Chemistry, Computer Science, Environmental
Science, Geology, Marine Science, Mathematics, Natural Science, Physics
