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Student Undergraduate Scholarship Application
Note: Use the
TAB key to move between fields. By hitting the ENTER key at any point,
you will be submitting your application.
Last Name:
First:
Middle:
S.S/Student ID #:
Sex:
Marital Status:
Race/Ethnic Origin: (optional)
Permanent Address:
Street:
City:
State/Country:
Zip Code:
Telephone:
Local Address:
Street:
City:
State/Country:
Zip Code:
Telephone:
Email Address:
Place of Birth:
Date of Birth:
U.S. Citizen?
Permanent Resident?
Texas Resident?
Where did you attend High School?
Military Service?
If so, which Military Service?
Classification at the University of Houston:
Your major:
Biomedical
Chemical
Civil
Computer
Electrical
Industrial
Mechanical
Engineering Unspecified
What is your anticipated date of graduation from the University?
Cumulative GPA:
Cumulative Hours:
Major GPA:
List memberships and positions held in organizations or
societies:
What honors or special recognitions have you received?
If you have any current scholarships, please list their
names and respective amounts.
To complete this form for submission
BY MAIL, please sign, date and send it to the address below.
I certify that the information is correct, and I hereby
grant permission to the University of Houston to release all of my student
records to potential scholarships sponsors.
Applicant's Signature:
Date:
Please return this application to:
University of Houston Cullen College of
Engineering
Dean's Office, Attn: Scholarship Committee
E421 Engineering Bldg 2
Houston, TX 77204-4007
OR
By submission of this ELECTRONIC FORM,
I certify that the information is correct, and I hereby grant permission
to the University of Houston to release all of my student records to
potential scholarship sponsors.
Date:
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