William D. Larson Scholarship Application
Chemistry Department, University of St. Thomas
Name_______________________________________________________
Hometown ________________________ State ____________________
Date of birth ______________________ UST I.D.
E-mail ___________________________________ Phone ________________________
Address ________________________________________________________________
City _______________________________ State _____________ Zip ____________
Did you bring any PSEO credits to St. Thomas? ________ How many? ____________
What other colleges (universities) have you attended?
___________________________________ Credits ___ Dates ____________
___________________________________ Credits ___ Dates ____________
How many college credits did you have before enrolling at St. Thomas? _______
In one or two sentences, describe your career goal:
Year: SO JR SR Major(s) ________________________________________
GPA ____________ Minor(s) ________________________________________
Faculty advisor ___________________________________
When do you expect to graduate from St. Thomas? ___________ Degree ____________
What is the highest degree you plan to pursue? Bachelors Masters Ph.D. Other______
List the science and mathematics courses that you will complete (not on your present transcript)
before you graduate from St. Thomas.
Course Name Course Number Course Name Course Number
No
Junior
N/A
2
Completed answers for questions 1, 2 and 3 on page 2 only.
1. List any awards, honors or scholarships you have received.
2. List activities in which you have participated at St. Thomas (such as clubs, publications,
music, art, sports, and student government).
College activity Dates participated Offices held
3. List jobs you have held in the past three years (including summer employment).
Job and kind of work Employer Dates of employment No. of hours worked per week
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Completed answers for questions 4 and 5 on page 3 only.
4. What are your immediate plans following your graduation from St. Thomas?
5. What are your professional aspirations? Specify how your current academic program and
your overall educational plans will assist you in achieving this goal.
Completed answers for questions 6 and 7 on page 4 only.
6. List past and present research activities associated with your interests in chemistry in which
you have regularly participated. Explain the duration, degree, and significance of your
involvement, including what responsibilities you had in the project. In the absence of formal
research experience, describe briefly any other skills or accomplishments you consider
significant and relevant to this application.
7. Describe any characteristics or other personal information about yourself or your family that
you wish to share with the review committee; this can include financial information or need.
Signature___________________________________ Date ___________________
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By placing my name above I acknowledge that all of the information I have given is true and
accurate to the best of my ability.