Noyce UG App 19-20

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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
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Noyce UG App 19-20

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