Equal Access Scholarship 2012-2013 Dear Equal Access Scholarship Applicant: Thank you for your interest in the Portland State University Equal Access Scholarship. We are pleased to provide you with the 2012-2013 Application Packet. The purpose of the Equal Access Scholarship is to attract outstanding students from diverse backgrounds and experiences, including racial and ethnic backgrounds that are traditionally underrepresented in higher education. Portland State University s Equal Access Scholars maintain good standing, contribute to the campus learning environment, and share their unique strengths and diverse perspectives through their involvement in on campus activities and participation in community service. If you wish to apply you may do so by submitting the attached Application and supporting documents by March 1, 2012. Your completed Application Packet will consist of: A completed Equal Access scholarship application; Two complete essays; A high school and/or college transcript (unofficial are accepted); A statement of financial need; A copy of your financial aid award (if available); and Two Letters of Recommendation and accompanying Recommender s Evaluation Form. Please check the box if you are currently enrolled for at least 12 credits hours, or have applied for admission to PSU. LATE OR INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. Return to: Office of Diversity & Multicultural Student Services ATTN: Equal Access Scholarship Committee Smith Memorial Student Union 425 - DMSS PO Box 751 Portland, OR 97207 0751 If you have any questions regarding the Equal Access Scholarship please contact the Office of Global Diversity & Inclusion by phone 503-725-5919 or via email diversity@pdx.edu. Sincerely, The Equal Access Selection Committee
Equal Access Scholarship Application 2012 2013 COMPLETE ALL SECTIONS. INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. Purpose: The purpose of the Equal Access Scholarship is to attract outstanding students from diverse backgrounds and experiences, including racial and ethnic backgrounds that are traditionally underrepresented in higher education. Program participants are students who contribute to the campus learning environment. These students share their unique strengths and diverse perspectives through their involvement in on campus activities and participation in community service. Eligibility requirements: o Meritorious academic record, and/or good academic standing; o Must be a prospective student who has applied for admission to Portland State and has been admitted, or be currently enrolled for at least 12 credit hours each term. Selection Criteria: The scholarship is awarded to students who meet the eligibility requirements, submit a complete application, and who best exemplify the goals of the Equal Access Scholarship. Priority for the Equal Access Scholarship is given to students with demonstrated financial need [as determined through tax forms or a statement of financial need] who are first generation college students. Are you a first generation college student? (First-generation means that neither parent has a 4 year college degree from a U.S. university) Yes No Have you been admitted to PSU? Yes No Full-time? Part-Time? For what term(s) are you applying for a scholarship (indicate year): Fall Winter Spring Summer Name: PSU SID: First Middle Initial Last Mailing Address: Preferred Phone: / Street Address Alternative Phone: / City State Zip Birth date: Male (M) or Female (F): Preferred Email Address Date or Term Admitted to PSU If admitted with conditions, please list the conditions: High School Attended: Graduation Date: GPA Name City/State Page 2 of 8
College(s) Attended Dates Attended College Credits Total: GPA: Major: Intended Major(s): Have you been formally admitted to the Maseeh College of Engineering & Computer Science? Yes No Have you been formally admitted to the School of Business? Yes No Highest level in school your father or guardian completed: Master s/ph.d./m.d./j.d. Bachelor s degree from a U.S. College or University Some college/associate s degree High school/ged Did not graduate from high school Unknown Highest level in school your mother or guardian completed: Master s/ph.d./m.d./j.d. Bachelor s degree from a U.S. College or University Some college/associate s degree High school/ged Did not graduate from high school Unknown Race/Ethnicity: You are encouraged to supply this information. However, you may decline without prejudicing your application in anyway. Please check any/all that apply: A Asian PI Pacific Islander H Hispanic/Latino AF African (North, South, East, or West) I American Indian or Alaskan Native ME Middle Eastern B Black (Non Hispanic) W White (Non Hispanic) O Other D Decline to respond A. Essay Requirement Print or type your name and student identification number on each page of your essay Please answer each question thoroughly. Limit 250 500 words per question. 1. Describe a specific instance when you felt marginalized or oppressed because of your social, economic, or cultural background. How did this affect you and how did you respond? How will you be a leader and/or advocate for others that have experienced oppression because of their social, economic, or cultural background? 2. Discuss how education will help you overcome oppression, surmount poverty, and/or fight discrimination. 3. What are your educational goals and career plans? NOTE: Please have your essay reviewed for grammar, content, and spelling by at least two individuals. Page 3 of 8
B. Please list all school and community activities in which you have been involved (Attach a separate sheet if necessary) School (clubs, government, sports, etc.) Dates Community (church, clubs, volunteer, etc.) Dates C. Please list all awards, honors, special talents or interests (Attach a separate sheet if necessary) Awards and honors Special talents or interests Page 4 of 8
D. Recommendations Recommendation letters should come from people who are familiar with your academic abilities, achievements, community involvement, and potential for college success. One recommendation must be from a teacher/professor, counselor/adviser, or principal. The other recommendation must be from an employer or community member. A completed copy of the Recommender s Evaluation Form (the following page) must accompany each Letter of Recommendation. Please have the writer include the following information: academic capabilities, motivation, personal characteristics, experiences, and achievements. All Letters of Recommendation must include: student s name, recommender s name and title, relationship to student. Please list below those individuals from whom you requested Letters of Recommendation. Name: Title: Date: Name: Title: Date: NOTE: You need to give the individuals you ask to write a letter on your behalf a copy of the attached Recommender s Evaluation Form to complete along with the Letter of Recommendation. Page 5 of 8
Equal Access Scholarship Recommender s Evaluation Form 2012 2013 The applicant named below is applying for a scholarship at Portland State University. Your assessment of the candidate will assist the scholarship selection committee. We ask that you provide the committee with a Letter of Recommendation and the completed Evaluation Form below. Return this Evaluation Form along with your Letter of Recommendation directly to the applicant in a sealed envelope. Please sign the sealed envelope over the closed flap on the backside of the envelope. Thank you. 1. Applicant s Name: How long and in what capacity have you known the applicant? 2. Please rate the applicant relative to other students or employees you have known in a similar context in recent years by placing an X on the point that best represents where the candidate lies on the continuum. Candidate Not Observed Exceptional Average Poor Leadership Self-discipline/work ethic Motivation Oral communication skills Written communication skills Academic performance Intellectual potential Summary Evaluation: I strongly recommend this applicant for the scholarship. I recommend this applicant for the scholarship. I cannot attest to the applicant s qualifications, but if awarded I believe the applicant would greatly benefit from the scholarship. I do not recommend this applicant for the scholarship. Signed: Date: Name (please print): Title: Phone: ( ) E-mail: May we contact you for additional information? Yes No Page 6 of 8
Equal Access Scholarship Recommender s Evaluation Form 2012 2013 The applicant named below is applying for a scholarship at Portland State University. Your assessment of the candidate will assist the scholarship selection committee. We ask that you provide the committee with a Letter of Recommendation and the completed Evaluation Form below. Return this Evaluation Form along with your Letter of Recommendation directly to the applicant in a sealed envelope. Please sign the sealed envelope over the closed flap on the backside of the envelope. Thank you. 3. Applicant s Name: How long and in what capacity have you known the applicant? 4. Please rate the applicant relative to other students or employees you have known in a similar context in recent years by placing an X on the point that best represents where the candidate lies on the continuum. Candidate Not Observed Exceptional Average Poor Leadership Self-discipline/work ethic Motivation Oral communication skills Written communication skills Academic performance Intellectual potential Summary Evaluation: I strongly recommend this applicant for the scholarship. I recommend this applicant for the scholarship. I cannot attest to the applicant s qualifications, but if awarded I believe the applicant would greatly benefit from the scholarship. I do not recommend this applicant for the scholarship. Signed: Date: Name (please print): Title: Phone: ( ) E-mail: May we contact you for additional information? Yes No Page 7 of 8
Equal Access Scholarship Internal Scholarship Award Approval form 2012 2013 Applicant s Name: PSU ID: Selection Rating Criteria: Essay Questions: /70 Community Service: /20 Letters of Recommendation: /10 Evaluator s Assessment /10 (Bonus) Evaluator Name: Signature: Total Score: Evaluator Name: Signature: Total Score: Evaluator Name: Signature: Total Score: Reviewed by: Executive Director, Office of Diversity & Inclusion: Signature of Approval Chief Diversity Officer, Office of Diversity & Inclusion: Signature of Approval Business Service Center Manager, Office of the President: Signature of Approval Page 8 of 8
Financial Information Are you currently employed? Yes No If yes, who is your employer? What is the average number of hours you work per week? Does your employer provide tuition assistance? Yes No If yes, what is the amount $ Please list your current financial status and the projected income/expenses as specified below. Please list your projected earnings from working in 2011. $ Please project your earnings through the academic year 2012 2 013. $ If your parent/spouse/other has supported you in the last year, what is the relationship and the amount? Relationship Please list current outside sources of additional funding for school and projected outside sources of additional funding for school for the 2012 2013 academic year. Academic year 2012 2013 Personal Loans $ Scholarships $ Scholarships $ Other funds Other funds As of today, what is your (and spouse s) total current balance of: Cash Savings Checking Debts Owing to: Amount owed Please list all present educational debts and amount owed: Estimated total educational cost to attend PSU for academic year 2012 2013: $ Please use the space below or attach a separate sheet to describe and clarify any financial issues, expenses, or constraints that are not addressed in the section above and to explain any significant (>$1,000) changes to your financial need for upcoming 2012 2013 academic year.