The Charles Elias Shepard Scholarship for Graduate Study 2015 Applications must be received by 4 PM, Wednesday, April 8 Save your completed application as a PDF document and email to [email protected]. Handwritten applications will not be accepted. Personal Information Name: _______________________________________________ Student ID: _______________________________________________ Local Phone and Email: Permanent Phone and Email: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Emory Career Information Graduation Semester: _______________________________________________ Major(s) : _______________________________________________ _______________________________________________ Minor: _______________________________________________ Cumulative GPA: _______________________________________________ GPA in Major(s): _______________________________________________ Academic Awards _______________________________________________ & Honors: _______________________________________________ _______________________________________________ _______________________________________________ Graduate Program Information Please list your top three graduate program choices. Note: If you are awarded the Shepard Scholarship, you must provide a formal letter of acceptance to your chosen graduate program. Degree (PhD, MA, MS, etc.) School / University Program or Concentration Accepted? 1) _____________ _______________________ ______________________ _________ 2) _____________ _______________________ ______________________ _________ 3) _____________ _______________________ ______________________ _________ Emory University National Scholarships & Fellowships Program 2015 Shepard Scholarship Application ‐ 2 Recommendations: Please have two (2) letters of recommendation submitted by April 8, 2015. The letters should be from individuals competent to assess your abilities and prospects in your proposed field of study. Electronic submission of letters is preferred; ask your recommenders to send an email attachment to [email protected]. If this is not possible, we will also accept hard copies dropped off at 300 White Hall, or mailed to: Dr. Megan Friddle White Hall, Suite 300 301 Dowman Drive Atlanta, GA 30322 List the names and universities/institutions of the persons from whom you have requested a recommendation. (1) _____________________________________________________________ (2) _____________________________________________________________ Transcripts: If you have attended another college or university to take courses for credit (not including Emory sponsored study abroad), order an official hard copy of your transcript from that school. We require a transcript from other schools only IF the course names and grades are NOT listed individually on your Emory transcript. Request that these transcripts be delivered by April 8, 2015 to: Dr. Megan Friddle White Hall, Suite 300 301 Dowman Drive Atlanta, GA 30322 The NS&FP office will add an unofficial Emory transcript to your application. Consent Form: (included below) Complete the consent form and submit it electronically with the other application materials. Letter of Acceptance: Submit a copy of a letter of acceptance from the designated graduate program, when available. Financial Award Declaration: Submit the following information for your preferred program (you may also include information for one alternate program):  Cost of Education, itemized  List of any financial aid, stipend, loans, and/or other support you will receive from the university or from other external sources (or forward when available)  Copy of official award letter (or forward when available) 2015 Shepard Scholarship Application ‐ 3 Essay: Attach (as a separate PDF document) an essay of no more than 1000 words detailing your professional and academic goals and explaining why you selected this course of study at the designated university. It is important to highlight the particular resources or characteristics of the program that led you to select it. Explain why the program offers the best available training in your field and how it will best advance your intellectual and career goals. Include a current version of your CV/résumé with your application materials. Scholarship Consent Form I, ___________________________, do hereby consent to the following initialed items in pursuit of the ________________________________________ (Scholarship/Award Name). _____ (REQUIRED) As required under the Family Educational Rights and Privacy Act, I give permission for my grade point average (GPA), transcripts, individual course grades, individual assignment grades, and/or other similar academic information to be used and discussed as a part of faculty and institutional letters of recommendation and endorsements and the applications for this award competition. I also give permission for the Office for Undergraduate Education to request unofficial and official copies of my transcript(s) as a part of the application process. _____ (REQUIRED) I certify that I have completed all required steps for the internal application process for this award (attach checklist). _____ (REQUIRED)I certify that all of the information I include in my application for this award, including listings of activities and awards, research undertaken or planned, and personal statements or other essays, is my own work and is accurate and honest to the best of my knowledge. _____ (REQUIRED) I give permission to the Vice President and Dean of Campus Life, the Senior Dean of Emory College of Arts & Sciences, and the Emory University Registrar or their designees to release information to the Emory College Office for Undergraduate Education from official college records pertaining to academic honesty and conduct offense violations, and to provide contextual information as to the severity of these offenses. This information may be given either in verbal or written form. _____ I waive any right I may have to view faculty and institutional letters of recommendation that are written for the purpose of this award competition. While copies of these letters may be provided to me by the authors, I understand that this is done as a courtesy by the author and does not affect this waiver. I understand that if I do not waive my right to view letters, my recommenders will be notified and may choose to withdraw their letters. _____ I grant permission for Emory University to use my public biographical information to publicize my nomination and/or receipt of this scholarship or fellowship. _____ I consent to have copies of my scholarship essays retained indefinitely and anonymously in the Office for Undergraduate Education and understand that they may be made available to future applicants as an example for them to review as they prepare their own applications. ______________________________ Type name in lieu of signature _______________ Date