Current Student Undergraduate Scholarship Application (Note: Use the TAB key to move between fields.) Required Information Last Name * First Name * Middle Name PSID Number * UH E-mail Address * Will you have completed the following applicable courses by the end of the Spring 2018 semester? * ENGI 1100, ENGI 1331, and one of: BIOE 2331, CHEE 2331, CIVE 2330, ECE 2201, INDE 2333, MECE 2336, PETR 2311 - Select -YesNo When is your anticipated date of graduation from the University? * - Select -December 2018May 2019August 2019December 2019May 2020August 2020December 2020May 2021August 2021December 2021 Do you need an in-state tuition waiver? * (Click here for more information about tuition waiver.) - Select -YesNo Involvement and Awards Organization or Society Membership: Alpha Pi Mu: Industrial Engineering Honor Society American Association of Drilling Engineers (AADE) American Institute of Chemical Engineers (AIChE) American Society of Civil Engineers (ASCE) American Society of Mechanical Engineers (ASME) Arab American Association of Engineers and Architects (AAAEA) Biomedical Engineering Society (BMES) Chi Epsilon: Civil Engineering Honors Society Engineers Without Borders Eta Kappa Nu: Electrical Engineering Honors Society Honors Engineering Program (HEP) Institute of Electrical and Electronics Engineers (IEEE) Institute of Industrial Engineers (IIE) Latinos in Science and Engineering (MAES) National Society of Black Engineers (NSBE) Omega Chi Epsilon: Chemical Engineering Honors Society Phi Sigma Rho: Engineering and Engineering Technology Sorority Pi Epsilon Tau: Petroleum Engineering Honor Society Pi Tau Sigma: Mechanical Engineering Honor Society PROMES PROMES Action Committee (PAC) Society of Asian Scientists and Engineers (SASE) Student Government Association (SGA) Student Program for Materials Science and Engineering Society of Hispanic Professional Engineers (SHPE) Society of Petroleum Engineers (SPE) Society of Women Engineers (SWE) Subsea Engineering Society SES Tau Beta Pi National Engineering Honor Society Triangle Fraternity UH Robotics Team Other Other Other Other Organization or Society Membership: Other Organization or Society Membership: Other Organization or Society Membership: Leadership: President Vice-President Secretary Treasurer Outreach Membership Industry Liaison Historian Webmaster Chair Member Initiate Mentor Other Other Other Other Leadership: Other Leadership: Other Leadership: Current Scholarships or Grants Awarded: Top 10 Percent high School Graduate Scholarship Academic Excellence Scholarship Greater Texas Foundation Scholarship National Merit Scholarship Finalist Tier One Scholarship Provost’s Undergraduate Research Scholarship (PURS) Summer Undergraduate Research Fellowship (SURF) Houston Livestock Show and Rodeo Scholarships Terry Foundation Scholarship Transfer Excellence Scholarship Terry Foundation Transfer Scholarship Pell Grant Undergraduate Engineering Scholarship Other Other Other Other Undergraduate Engineering Scholarship: Other Scholarships or Grants Awarded: Other Scholarships or Grants Awarded: Other Scholarships or Grants Awarded: Other Scholarships or Grants Awarded: Total Scholarship/Grant Amount anticipated for 2018-2019 school year: What additional honors or special recognitions not previously listed have you received? University of Houston award or recognition Cullen College of Engineering award or recognition Department award or recognition Other Other Other University of Houston Award or Recognition: Cullen College of Engineering Award or Recognition: Department Award or Recognition: Other Honors or Special Recognitions: Other Honors or Special Recognitions: Other Honors or Special Recognitions: Community Service Activities: Engineering Organization PROMES University of Houston Organization Honors College Organization Other Other Engineering Organization: PROMES: University of Houston Organization: Honors College Organization: Other Community Service Activities: Other Community Service Activities: Optional information — used to determine specific scholarship awards U.S. Citizen? - None -YesNo Permanent Resident? - None -YesNo International Student? - None -YesNo Texas Resident? - None -YesNo Languages spoken other than English: Where did you attend High School? Military Service? - None -YesNo If so, which Military Service? Cullen College of Engineering Endowed Scholarships If you are applying for a specific endowed scholarship(s), please indicate which one(s) below. Houston Gas Processors Association Midstream Endowed Scholarship Cobb/Fendley Scholarship Endowment Belgacem Lies Baghdadi Memorial Scholarship Endowment Wilbur L. and Judy L. Meier Award Endowment Fund Houston Chapter American Petroleum Institute Scholarship Endowment Houston Chapter of the Society of Maintenance and Reliability Professionals Scholarship Endowment Baker Hughes Engineering Excellence Scholarship Endowment L. Douglas and Jeannette C. Power Endowment for Employed Engineering Students Leonard A. Porter Memorial Scholarship Endowment Huitt-Zollars Endowed Scholarship Gerri and Larry Snider Endowed Scholarship Todd B. Colvin Scholarship Endowment Abraham E. Dukler Scholarship Endowment Bill and Gail McNeese Scholarship Endowment Simon Yee On Chow Endowed Scholarship Allen G. and Cleo V. Pike Jr. Scholarship Endowment Please describe how you meet the specific criteria for the endowed scholarship(s) below. To submit this form ONLINE 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. 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. * 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. I understand that if I do not meet the minimum requirements listed, I will not be considered for the scholarship. * I understand that if I do not meet the minimum requirements listed, I will not be considered for the scholarship. I understand that the application will be reviewed after the deadline listed, and decisions will be made based on the information available at that time, including the Fall 2018 course schedule. * I understand that the application will be reviewed after the deadline listed, and decisions will be made based on the information available at that time, including the Fall 2018 course schedule. Applicant's SIgnature * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.