Noyce UG App 19-20

PLEASE TYPE 2/7/18
NATIONAL SCIENCE FOUNDATION
ROBERT NOYCE TEACHER SCHOLARSHIP PROGRAM
UNDERGRADUATE SCHOLARSHIP APPLICATION FOR JUNIORS AND SENIORS AT UT ARLINGTON:
• Secondary Life Science, Chemistry, Physical Science, Physics, or Mathematics Teacher Certification
2019-2020 Applications - $10,000 SCHOLARSHIP (over two semesters)
Applications for students seeking the above noted certifications and accompanying recommendation(s) must
arrive no later than May 15, 2019.
To be eligible for this scholarship, one must be a junior, senior, or graduate student with an undergraduate major in a STEM field
or be enrolled in/planning to enroll in and complete teacher certification at The University of Texas at Arlington. STEM (Science,
Technology, Engineering, and Math) fields eligible for teacher certification include: biology, geology, chemistry, physics, and math.
Terms of the scholarship require students to complete the UTA program and earn certification, then teach in a high need district
for 2 years (per each year the scholarship is received). If any terms are not met, the recipient is required to repay the scholarship
funds to UTA. High need districts include Dallas, Fort Worth, Arlington, Irving, Cedar Hill, Hurst-Euless-Bedford and others.
Supporting materials include recommendations and transcripts that cover at least your last 60 hours of undergraduate student and
any graduate work. (Transcripts may arrive separately). Please send your application and supporting materials to:
Dr. Ann Cavallo
Assistant Vice Provost and Director, Center for Research on Teaching and Learning Excellence
Co-director, UTeach Arlington, Distinguished University Professor of Science Education
c/o Jamie Williams
UTA Box 19043
The University of Texas at Arlington
Arlington, TX 76019-0777
Name:
UTA ID#:
Last First Middle Assigned by Admissions
Address (while attending school, include City, State, Zip Code):
Phone Number:
Alternate phone number:
Permanent Home Address (include City, State, Zip code):
Main email:
Alternate email:
Ethnicity: _Date of Birth: Gender:
Degree(s) held and/or current major:
Desired Certification Area:
Secondary (Please Specify):
Chemistry
Life Science
Composite Science Mathematics
Middle Level:
Science/Math
Physics
Physical Science
Physics/Mathematics
Undergraduate Grade Point Average:
Cumulative *Science_ **Mathematics
*Science grade point average should include all classes with a BIOL, MATH, CHEM, GEOL or PHYS prefix
**Mathematics grade point average should include all classes with an MATH prefix

Community Colleges and Universities Attended (please include name of institution and dates
attended):
If you attended a community college, did you transfer to UTA or did you just take some classes?
When do you expect to graduate from UTA?
How did you hear about this program? (If you heard about this program through a class announcement,
which class?)
Teaching Experience (formal or informal):
Scholarships, Awards, Special Recognition:
Professional Organizational Memberships:
Community Activities/Memberships:
Volunteer Service:

Research Experience:
Describe your level of financial need:
Why do you want to become a certified teacher? (Attach additional sheet if necessary.)
Applicant’s Signature
This material is based upon work supported by the National Science Foundation under Grant No. 1439914.
Acceptance of this scholarship requires a commitment to teach at least two years in a high need school district, as defined by the Texas Education
Agency. Failure to complete this commitment converts the scholarship to an unsubsidized student loan, repayment of which is due 45 days after the
cessation of teaching in a high need school district.
Please indicate with your signature below allowing the College of Education to share your UTA classification (junior, senior, post- baccalaureate),
GPA, mailing address, and progress towards graduation and fulfilling the teaching requirement with the funder of this program – the National Science
Foundation. This is a requirement of the funding agency.
Date
Applicant’s Signature
Date
You may be entitled to know what information The University of Texas at Arlington (UTA) collects concerning you. You may review and have UTA correct this information
according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023, 559.004 of the Texas Government Code. For more information, please see our
Internet Privacy Policy.
According to state law, students attending post-secondary institutions who are related to a current member of The University of Texas System Board of Regents are prohibited from
receiving scholarships unless the scholarship is awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B misdemeanor to file a false statement.
Are you related to a member of the U.T. System Board of Regents? Yes _ No
If yes, please circle the most appropriate answer below indicating your relation to any member of the Board of Regents
1. Regent’s parent, daughter, son
2. Regent’s brother, sister, grandparent, grandchild
3. Regent’s great-grandparent, great-grandchild, uncle or aunt (brother or sister of parent), nephew or niece (son or daughter of brother or sister)
4. Regent’s spouse, spouse’s child, spouse’s parent, child’s spouse, or parent’s spouse
5. Regent’s spouse’s brother or sister, spouse’s grandparent, spouse’s grandchild, brother or sister’s spouse, grandparent’s spouse, or grandchild’s spouse.
Applicant’s Signature
Date