Application Checklist, S-STEM at UH Hilo
M
AKE SURE YOUR APPLICATION PACKET IS COMPLETE!
Either print, sign, and mail the form along with all your supporting documentation in hard copy; OR
Use the fillable pdf form and send as attachment from your email address. Be sure to include your
supporting documentation as scanned attachments too.
S-STEM Application Form
Proof of U.S. Citizenship or Permanent Resident status, acceptable documentation:
o For U.S. Citizens:
Copy of your United States Passport, the page with your name and photo: OR
Copy of your Birth Certificate confirming a United States place of birth
o For US Nationals:
Copy of your Passport, the page with your name and photo
o For Permanent Resident Aliens:
Copy of your Passport, the page with your name and photo: AND
Copy of your Permanent Resident card (“Green Card”), front and back
Official High School Transcripts
List of your Mathematics courses
o Current courses with your grade as of the date of your application (most recent report card is
sufficient)
o Past courses with your final grade (should be included in your transcript)
Official SAT Scores, or ACT with writing part completed (you may send us a copy while we wait for
the official results to arrive at UH Hilo)
Personal Statement
o Feel free to include as much detail about yourself as you feel necessary (See instructions in
the Application Form)
At least one letter of recommendation from a High School Mathematics and/or Science teacher.
o Please have your teacher send the letter of recommendation directly to Ms. Terrilani Chong,
address below
o Letter must be in a sealed envelope with your teacher’s signature across the seal
Copy of your submitted University of Hawaii application, if submitted.
How to submit:
Electronically: You may submit by email attachment, including all supporting documents as
scans, to terrilan@hawaii.edu
using the subject line “S-STEM Application
In hard copy: Y
ou may also mail a hard copy of your application and supporting documents to:
Ms. Terrilani Chong; University of Hawaii at Hilo S-STEM Program;
200 West Kawili Street; Hilo, HI 96720
Early subm
ission is strongly encouraged.
Acceptance in
to the S-STEM Program will be decided after your Pell Eligibility is confirmed
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
Application Form for
Scholarships in Science, Technology, Engineering, and Mathematics (S-STEM)
at University of Hawaiʻi at Hilo
*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
PERSONAL STATEMENT (Can be attached separately)
Succinctly describe your future goals in terms of college education and career in science, technology, engineering and or mathematics.
You may, but are not absolutely required to, include the following:
Begin by sharing a little about yourself and your family background:
o Are you the first member of your immediate family to attend college? Or maybe in the first generation of your family to do so?
o What are your favorite subjects in school? Why?
o Do you have hobbies?
o How do you spend your leisure time?
What experiences have you already had that sparked your interest in STEM?
Have you been a member of any STEM-related clubs during high school or intermediate school? (such as math or science clubs, robotics clubs
or programs, computer science clubs)? If yes, please state the name of the club, your role, and level of involvement.
Do you have any awards in STEM-related subjects or activities? If so, name the award and the level they are for (High School, Intermediate
School, local, state, national?)
How do you see yourself using your STEM degree in the future?
Feel free to include any other information you think is important for our consideration of your application.
Good luck!
Application Form for
Scholarships in Science, Technology, Engineering, and Mathematics (S-STEM)
at University of Hawaiʻi at Hilo
*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