The Lehman College Computer Science and Mathematics Scholarship Program

Application Form

 

Contact Information:
 

Name:

 

Student ID # 
(often social security #):

 

Address:

 

Undergraduate or Graduate student?

 

Major:

 

Grade Point Average:

 

Expected Graduation Date:

 

Phone number:

 

E-mail address:

 

Citizenship:

 

United States

 

Permanent Resident

 

Other

Ethnicity (optional):

 

Member of Lehman Scholars Program or Honors College?

 

Date you submitted Pell Grant
application (FAFSA):

 

Education:
 

High School Attended:

  

Date of Graduation:

 

Colleges Attended:

Institution 

# of Credits & GPA

Major and Degree 

Dates Attended

 

 

 

 

 

 

 

 

 

 

 

 

College English Courses Completed:

Institution 

Course Name 

Course #

Grade

Date Completed

 

  

 

 

 

 

  

 

 

 

 

 

 

 

 

College Mathematics Courses Completed:

Institution 

Course Name 

Course #

Grade

Date Completed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

College Computer Science Completed:

Institution 

Course Name 

Course #

Grade

Date Completed

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

Please attach or send transcripts of all college work.  For Lehman students, you may attach unofficial transcripts.  For work at all other colleges, official transcripts are required.
 

Work Experience:
 

Company Name

Job Title

Dates

Supervisor's Name

Phone #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please also attach a copy of your resume.  If needed, include a more detailed description of your work experience on your resume.
 

Essay:

Please include a short essay (1-2 pages) describing your past experiences with computers, leadership and the community, your current academic goals, and your plans for the future.  You may include special circumstances that you would like considered in the evaluation of their application.
 

References:  

Three letters of recommendation need to be submitted.  Each letter must be accompanied by the  recommendation form  and may be sent separately from the application.  At least two of the recommendation letters must come from professors familiar with your academic work.  The third letter can be from someone familiar with your work or community leadership activities.
 

Signature:

I certify that the information provided on the form is accurate and correct.  I also release the use of my transcripts and financial eligility forms to the CSM Scholarship Program for the use of evaluating my application.  The CSM Scholarship program has my permission to contact my references and employers listed for the use of evaluating my application.
 

Signature:

 

Date: