UMB Computer Science and Mathematics Scholarship (Fall 2005)




_________________________________                              _______________________________

Name                                                                                        Student ID


Street Address                                                            City                                            State                        Zip


____________________________                                     _________________________

Daytime Telephone, with area code                                       Evening Telephone, with area code


____________________________                                        _____________

e-mail address (please print clearly)                                       Date of Birth


Citizenship Status (circle one):      U.S. Citizen or National          Permanent Resident         Refugee Alien




Previous Education: ________________________               What school?  ____________________________


Date of admission to UMass Boston _________  Major  ___________________________________


Number of credits earned at UMass Boston    ___________


Estimated graduation date ___________________


Career Goal ___________________________________________________


Other institutions:  List all other colleges you have attended





Estimate the amount you owe in educational loans  __________________________


Were you eligible for student financial aid through UMass Boston for the previous academic year? ___ Yes  ____ No

(Note:  If you answer "no", then you are not eligible for a scholarship and should not complete this application.)


What is the total amount of aid you are receiving that does not have to be repaid?   ___________________


What is the total amount of aid you are receiving that does have to be repaid (loans)?  _________________


Total amount of aid you received last year through the Office of Merit-based Scholarships __________



During the school year, how  many hours per week do you work?  _________________


List your current employment information

Name of company _________________________               Dates of employment ________________________


Duties _______________________________________________________________________________     

The following information is optional and will not affect your application.  You are asked to provide this information by the National Science Foundation, for demographic purposes.


Gender:   ____  Male              _____ Female


Ethnicity (check one):   ____ Hispanic or Latino      _____ Not Hispanic or Latino           


Racial Background (check all that apply):

_____ American Indian or Alaska Native

_____ Asian

_____ Black or African-American

_____ Native Hawaiian or Other Pacific Islander

_____ White


Disability Status (check all that apply):

_____ Hearing Impaired

_____ Visual Impaired

_____ Mobility/Orthopedic Impaired

_____ Learning Disability

_____ None           



I certify that all the information on this application is true.  My signature further signifies my permission to release all information contained in my Scholarship Application Packet, as well as relevant information on record at the University of Massachusetts Boston, to any and all persons involved in the selection of scholarships, for the sole purpose of consideration for scholarship awards.  I further consent to the release of such information for reporting purposes to the National Science Foundation.


Signature:  ______________________________      Date:     ______________                                                 






Application package checklist:

            ____ completed application

            ____ most recent transcript

            ____ statement of career goals

            ____ letter of recommendation arranged to be sent to Prof. Cohen

            ____ financial aid statement (optional)


When complete, please send the application to:

Prof. Robert Cohen

Department of Computer Science

UMass Boston

100 Morrissey Boulevard

Boston MA  02125-3393.

You may also drop it off in his mailbox in the Math/CS office (S-3-132).  Completed applications are due by Friday September 23, 2005, 5PM.