Priscilla Carney Jones Scholarship Application

The Priscilla Carney Jones Scholarship was established to provide scholarships for female undergraduate majors in chemistry or related disciplines who are beginning their junior or senior years of study.

APPLICANT INFORMATION

First Name *

MI

Last Name *

Notification Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Citizenship Status *

US Citizen

US Permanent Resident

Where did you learn about this program? *

If you are an ACS member, please provide your membership number.

Demographic Information

We ask you to provide this voluntary information below because the American Chemical Society is eager to support programs that benefit underrepresented groups in the chemical sciences, and your responses are helpful to these efforts and to all facets of our services to all members. Individual responses are held in strictest confidence and have no bearing on consideration.

Date of Birth (mm/dd/yyyy)

Country of Birth

Racial-Ethnic Origin

Do you consider yourself to be a person with a disability?

Yes

No

NAME AND ADDRESS OF CLOSEST LIVING RELATIVE

First Name *

MI

Last Name *

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Relationship *

ACADEMIC INFORMATION

College/University *

Current Status *

Sophomore (Rising Junior)

Junior (Rising Senior)

Degree Pursuing *

Degree Start Date (mm/yyyy) *

Expected Completion Date (mm/yyyy) *

Major *

Minor

Overall GPA *

Research Advisor (First, MI, Last) *

Email *

Academic Advisor (First, MI, Last) *

Email *

Estimated unmet financial need for upcoming academic year
Unmet financial need is equal to the cost of tuition, academic fees, and books minus the estimated family contribution (indicated on Student Aid Report) and any scholarships/grants. *

APPLICATION MATERIALS

Applicant Statement
In 500 words or less, please describe why you are a good candidate to receive this scholarship.
*

Community Service
In list form, please describe all of your community service activities and related responsibilities.
*

Leadership
In list form, please describe key leadership roles that you have fulfilled.
*

Presentations/Publications
In list form, please indicate all of the research presentations you have given and publications you have been a part of during your undergraduate career.
*

Research Summary
In 250 words or less, please summarize the specific nature of the research (or planned research) and your role in it.
*

Future Goals
In 250 words or less, please summarize your future plans and goals, including plans after you have finished your undergraduate degree.
*

Resume / C.V.
Please upload a recent resume or C.V. (PDF Please)
*

Award Letter
Please provide an electronic copy of the most recent award letter from your institution which outlines all costs of attendance and itemizes any financial awards, scholarships, or grants that you are receiving. (PDF Please)
*

ADVISOR REFERENCE FORM

Please have your academic/research advisor complete the form at https://fs7.formsite.com/acsdiversity/form559168937/secure_index.html. In this form the advisor will be required to upload a letter of recommendation. This form must be submitted by the application deadline.

APPLICANT CERTIFICATION

I certify that the information provided in this application is accurate and that I meet the criteria as stated in the award qualifications to the best of my knowledge. *

Confirm

Initials *

Date *