1. No category

APPLICATION for PERSIST Scholars Program
In-Coming Freshman, 2015
1. Personal Information
Applicant’s name: __________________________________
Major
SAT verbal
SAT math
SAT total
EFC
$
HSR (#/#)
HSR (%ile)
GPA (student)
GPA (max)
Mailing address: ___________________________________
___________________________________
___________________________________
Home phone: ___________________________________
Cell phone: ___________________________________
(if available)
e-mail address: ___________________________________
(if available)
Check all that apply:
o Abbott District
o EFC by CB Estimator
o EFC by FAFSA
Are you a first-generation
college student?
o yes
o no
I prefer to be contacted at my:
o home phone
o cell phone
Do you check this e-mail address
regularly? o yes
o no
Please check the boxes that correspond with career choices that you are considering:
 medical school
 other health care profession
 research (graduate school);
 teaching
 working in industry
 other ________________________  undecided
2. References and High School Information
A. Please provide the name and contact information of two science teachers who could comment on
your motivation to pursue a career in science. One must be your most recent science teacher.
Teacher’s name: _______________________
Teacher’s school phone number: ____________________
e-mail address:_____________________
Subject(s) that you took with this teacher and grade level(s): __________________________________
Teacher’s name: _______________________
Teacher’s school phone number: ____________________
e-mail address:_____________________
Subject(s) that you took with this teacher and grade level(s): __________________________________
Guidance counselor’s name: ________________ Dates of your spring break: ___________________
Name and city of high school: __________________________________________________________
If you have attended more than one high school, please provide details:
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3. Essays
A. Describe what motivates you to pursue your chosen major and a career in science, including
a statement of why science is inspirational and exciting to you.
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B. Describe what your possible career goals may be and why you are considering such career path(s).
(You might have more than one; you are not being evaluated on your choice of career goals.)
C. Please provide any additional information about you or your personal circumstances that may
assist the committee in evaluating your application to the program.
4. Signatures
•
•
•
I/we certify that the information provided is accurate and is complete to the best of my/our ability, and
I/we certify that the student is a citizen of the United States, National of the United States (as defined in Section 101
(a) of the Immigration and Nationality Act), an alien admitted as refugee under Section 207 of the Immigration and
Nationality Act, or an alien lawfully admitted to the United States for permanent residence, and
I/we hereby give permission for members of the TCNJ PERSIST Scholars Program Project Team to access and
review materials on file at TCNJ, including (but not limited to) the student’s application materials to the College,
application materials for the PERSIST program, academic records, financial aid records, and special needs
assessments, in accordance with Family Educational Rights and Privacy Act (FERPA) regulations.
Signature of Student: _____________________________________________ Date: ______________
Student’s date of birth: ______________________ Student’s SSN: _____________________
Required if student is a minor:
Signature of parent/legal guardian: ___________________________________ Date: _____________
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Instructions for
Application for PERSIST Scholars Program
In-coming Freshman, 2015
Personal Information:
There are two rows of boxes near the top of the application form. The blank ones with no heading are for use by
TCNJ; please leave those boxes blank. Please enter the following information in the indicated boxes:
Major: Enter as is appropriate for you.
SAT verbal: Enter the highest score that you earned on the Critical Reading section of the SAT.
SAT math: Enter the highest score that you earned on the Mathematics section of the SAT.
SAT total: Add your SAT Verbal and Math scores together and enter the sum here (do not include the
Writing section score in the total).
Students who have taken only the ACT may enter those scores in lieu of SAT scores, but if you have
taken the SAT, you must provide the scores earned.
EFC: Enter the dollar amount for your Estimated Family Contribution and check the appropriate boxes
immediately below the section.
Students from Abbott Districts are not required to provide their EFC at the time of application, but must
provide the information before they can actually receive the scholarship money.
The College Board’s EFC estimator is available at:
http://apps.collegeboard.com/fincalc/efc_welcome.jsp/.
To determine your actual EFC, complete the FAFSA at: www.fafsa.ed.gov/.
HSR (#/#): Enter your high school class rank as your class rank divided by the total number of
graduating seniors in your class (e.g., 33/341). (Indicate n/a if not available.)
HSR (%ile): Enter your high school class rank as a percentile (e.g., 91%).
You are not required to provide high class school rank in both of these formats, but you should provide
it in at least one of these formats. (Indicate n/a if not available.)
GPA (student): Enter your cumulative GPA. If your school reports your overall average grade as a
percent score, enter that number instead of the GPA.
GPA (max): Enter the maximum GPA at your school (it often is 4.0 or 4.5, but it varies from school
to school). If your school reports grades as a percent score, enter ‘100%’ in this box.
Are you a first-generation college student? If either of your parents or any of your grandparents graduated from
college, check the ‘no’ box. If either of your parents attended college, but did not graduate, or if they currently
are attending college, check the ‘no’ box, but describe the details in Essay C. Otherwise, check the ‘yes’ box.
Be sure to indicate whether you prefer to be called at your home phone or cell phone number. No phone calls will
be made during normal school hours (i.e., no calls will be made to before 3:30 p.m. on school days). Be sure to
indicate whether you check your e-mail regularly. There is no penalty for not having an e-mail address or for not
checking it regularly, but we must know whether or not this is a reliable way to contact you.
Career choices. Be sure to check the boxes of all career options that you may be considering.
References and High School Information:
Provide the name and contact information of two science teachers who will be able to comment on your
motivation to pursue a career in science. One must be your most recent science teacher. The second can be any
science teacher from high school. You may list a recently-retired teacher or a teacher who has changed schools,
but please indicate this on your application. Also, provide the name and contact information of your high school
guidance counselor. Do not include any letters of recommendation with this application.
Please be sure to indicate the dates of your spring break. If you have attended other high schools, please indicate
the name, city and state of the school, as well as the grades for which you were enrolled at the other high school.
You do not need to mention your attendance at other schools during summer school sessions.
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Essays:
Essays A and B are required. Essay C is optional. Please confine your answers to the topic requested. Your essay
will not be judged on its creativity. Do not provide essays developed for general applications to colleges. Please
do not use the essays to express why you feel you deserve the scholarship, what you would do if you were
awarded the scholarship, or how grateful you would be if you were awarded the scholarship. Do feel free to
describe circumstances that would have a bearing on our understanding of your personal situation in Essay C. If
your economic situation has recently changed and is not reflected in your EFC, please explain the circumstances
in Essay C. If your essays are typed, please single-space; use fonts no smaller than 11 point. Please be concise
and do not exceed the allowed space.
Signatures:
Make sure that you sign the application form and provide your birth date. If you are under 18 years of age, your
parent or legal guardian also must sign the application form. Your social security number is needed to access
your FAFSA information.
General:
a. Make sure that you have completed the on-line Intent to Apply Form as soon as possible. It is available at
https://tcnj.qualtrics.com//SE/?SID=SV_4HevUtG5oJ37l09. Students (both biology and chemistry
majors) who do not have access to the internet or to a computer printer or who do not have an e-mail
account may call the TCNJ Department of Chemistry (609-771-2434) during business hours to request
that a PERSIST Application Form be sent to them by mail. (All information requested on the Intent to
Apply Form also will be collected over the telephone at that time.)
b. Print out this application form as a pdf file or download it as a Word file. You may fill out the application by
hand or use a computer/typewriter. We recommend filling out the entire first page by hand. Neat,
handwritten applications will receive identical evaluation to those that are typewritten.
c. In addition to the application form, you also must submit a copy of either the College Board Estimator report
of your estimated Expected Family Contribution (EFC) or the FAFSA report of your EFC.
d. Please note the DEADLINES:
April 13st is the priority deadline for consideration for the PERSIST scholarship. Applications received
after that date will be considered on a rolling basis as long as slots remain available.
To complete a FAFSA, go to www.fafsa.ed.gov/.
As soon as you have received your EFC report from FAFSA, please send a copy to the address
below. If you have questions about completing the FAFSA form, please contact the TCNJ Office
of Student Financial Services at 609-771-2172.
Mail the completed application form and a copy of the EFC document to:
PERSIST Scholars Program
Department of Chemistry
The College of New Jersey
P.O. Box 7718
Ewing, NJ 08628-0718
You may also scan your application and email it to [email protected], followed by a hard copy mailed to the above
address
Questions about either the PERSIST Scholars Program or the application process may be directed to Dr. Benny
Chan, Co-Director, PERSIST Scholars Program at 609-771-2471 or [email protected]. (In e-mails, be sure to
include the word PERSIST in your subject line and your full name in the body of the message.)