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CFG Scholars Program TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES Completeness and neatness ensure your application will be reviewed properly. FOR SCHOLARSHIP MANAGEMENT SERVICES USE ONLY

STUDENT DATA

I.D. #

AA

PD

GPA

Byrd

Last Name Permanent Home Mailing Address 752

SATCR

603

)

Email Address

dsbyrd@umich.edu

380-08-5061

01

Date of Birth: Month

14

Day

F ✘ Male F Black/African American

F Female F Multi-Racial

F Asian

F Hispanic/Latino

F Native Hawaiian/Pacific Islander

Last Name

Byrd

E Number

J001682

Work Telephone ( Year

1959

Bank Teller

) 321-6998

djb821@yahoo.com

Email Address

030 Manchester

City

New Hampshire

State

603

03104

ZIP Code

Relationship to Applicant

Mother

The applicant is a dependent of the employee F Yes F No

Is your base salary from CFG less than $100,000 per year? F Yes

School Name

Manchester High School Central Manchester

City

06

High School Graduation Date: Month State

NH

Telephone (

603

Year

F No

2006

) 624-6363

Name of postsecondary school you plan to attend. (If unknown, please list in order of preference the schools to which you have applied.) Use official school names. Do not use abbreviations.

University of Michigan

Ann Arbor

City

State

City

F 2 yr. Community or Junior College

F Vocational-Technical School

F Other, explain

Major or course of study: Degree sought: PDF FILLIN 4/09

1

2

3

4

Chemical Engineering

F Bachelor

F Associate

Copyright © 1988

MI

State

F 4 yr. College or University

Year in school next year:

CFG

J

Middle Initial

Department

399

Division/Subsidiary

1988

Year

F ✘ White

Donna

First

Day 21

08

S

03104

ZIP Code

F American Indian /Alaska Native

Date of Birth: Month

TOTAL

Middle Initial

NH

State

459-3764

Job Title

POSTSECONDARY SCHOOL DATA

ACTC

Apartment # N/A

Please indicate your status. (For statistical purposes only)

HIGH SCHOOL DATA

SATW

Daniel

First

Manchester

Social Security Number

EMPLOYEE PARENT OR GUARDIAN INFORMATION

SATM

Maple St.

City Telephone (

RIC/CS

Application postmark deadline June 8, 2009

5 Expected college graduation date: Month

F Certificate

Scholarship America

F Other

All Rights Reserved

06

Year

2010


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Sending a resumĂŠ does not replace any part of this application. If space provided in any section is inadequate, you may continue on additional sheets. Attachments must follow the same format. DO NOT repeat information already reported on the application form. Your name, address and name of this scholarship program should be included on all attachments. WORK EXPERIENCE

Describe your work experience during the past four years (e.g., food server, babysitting, lawn mowing, office work). Indicate dates of employment for each job and approximate number of hours worked each week. List amounts earned at each job. Employer/Position

University of Michigan/Planetarium Operator University of Michigan/Research Assistant University of Michigan/Undergraduate Instructor Little Caesars Pizza/Co-Manager

ACTIVITIES, AWARDS AND HONORS

To - Mo/Yr

Hours per Week

Amount Earned

09/2008 06/2008 06/2008 08/2003

Present 08/2008 07/2008 08/2007

15 55 40 30

$700 $1200 $800 $10000

List all school activities in which you have participated during the past four years (e.g., student government, music, sports, etc.). List all community activities in which you have participated without pay during the past four years (e.g., Boy/Girl Scouts, hospital volunteer, Special Olympics). Note all special awards, honors and offices held. Indicate whether high school or college activities. Activity 1.Astronomy Club 2.AICHE 3.Ping-Pong Club 4.Physics Club 5.Soccer

No. of Years Partic.

Special Awards, Honors

Offices Held

3 3 2 2 2

-

President Captain

6. 7. College Level

Activity 9. NHS 10. WLHS 11. Soccer

Activities

No. of Years Partic.

Special Awards, Honors

Offices Held

2 3 3

-

Treasurer -

4

Activities

-

12. Parks and

Recreation Volunteer 15. High School 13. 14.

8.

GOALS AND ASPIRATIONS

From - Mo/Yr

16.

Make a brief statement or summary of your plans as they relate to your educational and career objectives and long-term goals.

For years, my ultimate goal has been to perform fluid analyses and flow assurances on oil pipelines particularly in the Gulf of Mexico. The need to enhance our capabilities regarding oil extraction and purification is becoming more and more evident with each passing month. To that end, I feel very grateful to have matriculated to a university of such high quality as the University of Michigan. The Department of Chemical Engineering is providing me with a background fit to aid me in my endeavours regardless of my future profession, however I have been manipulating my courseload to increase my understanding of oil flow. In the years to come, I truly hope I can contribute greatly to rectifying the growing problem of the industry. Although tritely expressed, only time will tell if my educational background will suffice for my aspirations, but I feel as though I am giving the opporunity every chance possible.

Please describe how and when any unusual family or personal circumstances have affected your achievement in school, work UNUSUAL CIRCUMSTANCES experience, or your participation in school and community activities.

I feel as though my unfortunate family circumstances have been extremely detrimental to my learning while at the collegiate level. Only one week before my freshman year my mother informed me that she had filed for divorce. I spent the following two years attempting to console her while struggling with class considering my family caused my stress level to always remain at its peak. The divorce was finally finalized but destroyed both of my parents' credit in the process. Therefore, on top of class and my parents' situation, I had the added stress of an inability to pay for tuition and housing. This scholarship will mean the world to me considering I will not need to find a loan co-signer to replace my parents, and I will finally be allowed to focus on my studies stress free. CFG

PDF FILLIN 4/09

Copyright Š 1988

Scholarship America

All Rights Reserved


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APPLICANT APPRAISAL (REQUIRED)

To the Applicant: This section is required and must be completed in the format provided. If incomplete, your application will not be evaluated. The section is to be completed by a high school or college counselor or advisor, an instructor, or a work supervisor who knows you well. To the Adult Appraiser: You have been asked to provide information in support of this application. Please give immediate and serious attention to the following statements. When complete, please return to applicant. If you prefer, photocopy this section and return to applicant in a sealed envelope. A letter of recommendation does not replace this section.

The applicant’s choice of a postsecondary educational program is

F extremely appropriate

F very appropriate

The applicant’s achievements reflect his/her ability

F extremely well F excellent

F very well F good

F moderately well F fair

F not well F poor

F excellent

F good

F fair

F poor

F extremely well F extremely well

F very well F very well

F moderately well F moderately well

F not well F not well

F extremely well

F very well

F moderately well

F not well

F excellent

F good

F fair

F poor

The applicant’s ability to set realistic and attainable goals is The quality of the applicant’s commitment to school and/or community is The applicant is able to seek, find, and use learning resources The applicant demonstrates curiosity and initiative The applicant demonstrates good problem-solving skills, follows through, and completes tasks The applicant’s respect for self and others is

F moderately

F inappropriate

appropriate

Comments

Appraiser’s Name

Title

Signature

Organization

TRANSCRIPT INFORMATION

Telephone (

)

Date

A complete transcript of grades must be sent with this application. Grade reports are not acceptable. 1. Students currently or previously enrolled in college or vocational-technical school must include all college or vo-tech transcripts of grades from each school attended. Online transcripts must display student name, school name, grade and credit hours earned for each course, and term in which each course was taken. (Completion of high school Information below is not necessary.) 2. High school seniors and students who have completed less than one full quarter or semester of postsecondary education must include a high school transcript of grades and have this section completed by the appropriate school official. (A clear explanation of the school’s grading scale must also be submitted.) Cumulative Grade Point Average

Applicant ranks _______

Weighted: __________/4.0 scale

in a class of __________

Unweighted: ________/4.0 scale

School Official’s Signature

Date

School Official’s Address: Street

City

APPLICATION CHECKLIST

SAT Critical Reading

Math

Writing

English

Title

Math

Reading

Telephone ( State

Science Composite

)

ZIP

The student is responsible for submitting all materials to Scholarship Management Services on time. Incomplete applications will not be evaluated. This application becomes complete and valid only when all of the following materials have been received:

F F

Student Application with completed Applicant Appraisal Current Complete Transcript(s) of Grades (including grading scale)

Postmark deadline June 8, 2009 CERTIFICATION

ACT

All materials, including transcript, must be addressed to: CFG Scholars Program Scholarship Management Services One Scholarship Way, PO Box 297 Saint Peter, MN 56082

Scholarship Management Services has the sole responsibility for selecting recipients based on criteria as set forth in the program’s description. This application becomes the property of Scholarship Management Services. (It is recommended you keep a copy for your files.) I acknowledge decisions are final. I certify I meet eligibility requirements of the program as described in the guidelines and the information provided is complete and accurate to the best of my knowledge. If requested, I will provide proof of information, including an official transcript of grades. Falsification of information may result in termination of any award granted.

CFG

Applicant’s Signature

Date

Employee’s Signature

Date

PDF FILLIN 4/09

Copyright © 1988

Scholarship America

All Rights Reserved


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