Basic Information Last Name * First Name * UH ID Number UH Email * Citizenship - None -USPermanent ResidentForeign Texas Resident - None -YesNo Local Address Local Phone Alternate Phone Official Student Classification - None -Master’sPhD Overall GPA Major GPA (MECE courses only) # of MECE Hours Completed Semester Enrolled at UH Expected Date of Graduation Are you a working student? - None -YesNo If so, how many hours per week? Questions Please select the scholarship that you want to apply. - None -Chevron ScholarshipBP ScholarshipAmerican Bureau of Shipping Scholarship Please provide additional special information about you that you feel may be of interest to the Scholarship Committee. Please provide a statement regarding your financial need. Please list any volunteer work that you have done or leadership skills. Resume: Submit this form ONLINE I affirm that the information I have submitted in this application is true and I grant permission for this information to be validated. If awarded a scholarship, I authorize release of my name, GPA, and information on this form to the scholarship donor. Signature of Applicant * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019 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.