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Michigan Architectural Foundation 2012 Scholarship — Application

AIA Michigan Presidents' Scholarship
American Institure of Architects Scholarship
Kenneth Neumann Design Scholarship
Professional Concepts Insurance Acency Scholarship
HED Alvin Ernest Harley Graduate Scholarhsip
John Banicki Scholarship

Applicant: Please complete all sections of this application. If a question does not apply to you, use N/A. Neatness and completeness will be taken into consideration. Use a typewriter or print your answers. Your completed application must be received no later than March 30, 2012.

Personal Data

Last Name

First Name

Middle Initial

Home Address

City

State

Zip

Home Phone

College Phone

Current Age

Social Security Number (last 4 digits only)

Place of Birth

Date of Birth

Marital Status

Spouse's Name

Scholastic Information

Name of University

Date of Enrollment

Current year in school

Anticipated Date of Graduation

Major

What is your current grade point average?

Please attach a copy of your current College transcripts.

Financial Information

This section must be completed by the applicant in consultation with his/her parent(s), legal guardian or spouse. The information will be regarded as confidential and used only for the purpose of evaluation for the Scholarship. Please be as accurate as possible.

Father's Name

Father's Occupation

Father's Annual Income

Mother's Name

Mother's Occupation

Mother's Annual Income

Guardian's Name

Guardian's Occupation

Guardian's Annual Income

Spouse's Name

Spouse's Occupation

Spouse's Annual Income

How many dependents, other than yourself, are your parents supporting? Please provide name and age, and indicate if he/she is enrolled in college by placing and x by his/her name.

Name

Age

College Yes No

Name

Age

College Yes No

Name

Age

College Yes No

How much will you and/or your family be able to contribute to your education and living expenses for the coming school year?

Enter your estimated annual college expenses:

1. Tuition: $

2. Room and Board: $

3. Books & Supplies: $

4. Fees: $

5. Transportation: $

6. Personal: $

TOTAL PER YEAR: $

Indicate the amount of support you expect to receive from the following:

1. Summer Employment: $

2. Part-time work (work/study): $

3. Loans (specify below, 3-a): $

4. Scholarships (specify below, 4-a): $

5. Other Sources (specify below, 5-a): $

6. Savings: $

TOTAL PER YEAR: $

3-a:

4-a:

5-a:

Personal Statements

A. Personal Statements, write a brief statement describing your interest, experience, and plans related to architecture .

B. Leadership Statement, write a brief statement clearly demonstrating your involvement with leadership activities in your community, the local AIAS chapter, or in the design of the built environment.

C. Extracurricular Activities, describe the activities in which you participated during high school (and college if applicable). Indicate elected offices held, purpose of organization, community activities, athletics, hobbies and special talents.

Reference Letters

Provide three reference letters from individuals familiar with your leadership accomplishments. One of the reference letters must be by a faculty member of your university

Employment History

List below full-time, summer, or part-time employment and explain your duties and responsibilities (beginning with most recent).

Employment History A

From (MM/DD/YYYY)

To (MM/DD/YYYY)

Employer/type of business

Address

Position/Duties

Salary $

Employment History B

From (MM/DD/YYYY)

To (MM/DD/YYYY)

Employer/type of business

Address

Position/Duties

Salary $

Employment History C

From (MM/DD/YYYY)

To (MM/DD/YYYY)

Employer/type of business

Address

Position/Duties

Salary $

Employment History D

From (MM/DD/YYYY)

To (MM/DD/YYYY)

Employer/type of business

Address

Position/Duties

Salary $

I agree that the application and all attachments may be used for the purpose of evaluation and selection by the Michigan Architectural Foundation. I also state that all information provided is true and correct to the best of my knowledge.

Signature

Date

All forms, letters and transcripts must be received by March 30, 2012

Michigan Architectural Foundation

Increasing Public Appreciation of How Architecture Enriches Life

Michigan Architectural Foundation 2012 Scholarship — Application

Personal Data

Scholastic Information

Financial Information

Personal Statements

Reference Letters

Employment History