2017 Chuck McLane Scholarship ApplicationPlease Return to Your Council

Please TYPE All Answers and Submit as a WORD Document(Application should be saved as “First Name_ Last Name_Council Name_2017 Alcoa Scholarship”)

The Chuck McLane Scholarship is awarded to two Girl Scout Gold Award recipients who complete a Gold Award project in Science, Technology, Engineering or Math (STEM).This application qualifies Girl Scout Gold Award Recipients, who are starting college in the fall of 2017, to be considered for the $10,000 college scholarship provided by the Arconic Foundation (formerly Alcoa Foundation).

REQUIREMENTSWho is eligible to apply?

Girl Scout Gold Award recipients who completed a STEM Take Action Project (project involves a STEM field - Science, Technology, Engineering or Math)

Recipients who will attend an accredited four year college or university as a freshman beginning in the fall 2017 to pursue and complete studies in a STEM-related field. (At time of submission, applicants may not be enrolled in college yet but will have to confirm enrollment before scholarship can be awarded.)

The parameters and structures of the scholarship include: Scholarships are awarded to Gold Award recipients who completed an innovative,

sustainable STEM-related Take Action Project that has significant impact on a community.

Strong focus on girls from diverse and underrepresented communities. Recipients must be enrolled in an accredited four year college, beginning their freshman

year in the fall of 2017, and complete their studies in a STEM-field. Recipients will be required to submit transcripts after their sophomore year showing they

are pursuing studies in a STEM-related field and have maintained a grade point average of at least 3.0 to receive her second payment.

Distribution of payments will be as follows: Recipients will receive the first $5,000 for their freshman fall semester followed by the second $5,000 for her fall junior year.

Scholarship funds may be used exclusively to defray educational costs such as tuition, fees, books, and supplies, as well as room and board in a college dormitory.

DEADLINEApplicants must submit a completed application to their council by Application due date: February 13, 2017. Please contact your council for additional information. Applications MUST be typed and submitted as a Word document directly to your council.

SCHOLARSHIP NOTIFICATIONEach council is responsible for reviewing the applications they receive and for selecting up to two nominees. Councils also are responsible for submitting their nominations to Girl Scouts of the USA (GSUSA) by February 21, 2017. A panel of corporate and community leaders will assist GSUSA in selecting two scholarship recipients from the pool of nominees. Scholarship recipients will be notified by May 8, 2017.

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2017 Chuck McLane Scholarship Application FormPlease Return to Your Council

Please TYPE All Answers and Submit as a WORD Document (Application should be saved as “First Name_ Last Name_Council Name_2017 Alcoa Scholarship”)

Gold Award Recipient Information

First Name       Last Name       DOB      

Email       Phone      

Home Address      

Information on racial/ethnic background may be used to ensure a diverse representation when selecting the Chuck McLane Scholarship recipient.

Please check as many as apply:

American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander Hispanic White Other      

Date of HS Graduation      

Name of Gold Award Take Action Project      

Date Gold Award Project was Completed       (Project is “completed” when council/overseas committee gives final approval. Applicant may need to list future date and confirm project completion before scholarship can be awarded.)

Name of College applicant will be attending?       (At time of submission applicant may not be enrolled in college yet but will have to confirm enrollment before scholarship can be awarded)

College Start Date       College Graduation Date      

Council Information

Name of Council Where Gold Award Was Earned       Phone      

Council Contact       Email Address       Phone      

Name of Project Advisor       Email Address      

Describe your Take Action project and how you used Science, Technology, Engineering and/or Math. 200 words or less.

     

Describe how the project was innovative and address the project’s impact on the community and sustainability. 300 words or less.

     

Describe how you intend to use Science, Technology, Engineering and/or Math for your studies and/or career. 300 words or less.

     

OPTIONAL: Attach1-2 photos that best describe your STEM project.(Photo’s should be saved as “First Name_Last Name_Photo 1” or “First Name_Last Name_Photo 2”)__________________________________________________________________________I give the GSUSA permission to share information in this application with the Arconic Foundation for their final consideration.

     Applicant Signature

     Parent or Legal Guardian Signature