Scholarship Application Form - CSHEMA - EHS Leadership in Higher Education

First Name *

Last Name *

Street Address

Street Address 2

City

State / Province / Region

Postal / Zip Code

Country

Email *

Mobile Phone Number *

Student's Field of Study *

Name of Institution *

Mailing Address for Scholarship Office or Bursar *

Student's Institutional ID Number *

Are you currently registered as a full-time student? *

Yes

Type of Academic Calendar *

Anticipated graduation date (term & year; ex: Spring 2023) *

Do you have a full year of study remaining in your degree program (not including the current term)? *

Yes

Applicant Demographics
NOTE: All responses to the demographic questions below are optional. This information is requested only for CSHEMA’s internal tracking purposes and will not be used in determining scholarship eligibility.

Which of the following best describes you? Select all that apply.

Asian

Black or African American

Hispanic or Latino

Native American or Alaska Native

Native Hawaiian or Pacific Islander

White

Other

Choose not to disclose

Which of the following genders do you most identify with? Select one.

Female

Male

Other

Choose not to disclose

Have you ever served on active duty in the U.S. Armed Forces, Military Reserves, or National Guard?

U.S. Armed Forces

Military Reserves

National Guard

Other

Choose not to disclose

Document Upload

Upload Your One-Page Essay (1" margins, single-spaced, 10 point font) *

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Possible Points	Criterion
Disqualification	Failure to meet the Eligibility criteria and/or submit required documents.
0-15 points	Relevance: Does the essay address the issue identified in the prompt and focus on the applicant’s college or university campus?
0-20 points	Innovation: Has the applicant described innovative ways their campus EHS professionals addressed the identified issue?
0-20 points	Effectiveness: Will the other ideas, strategies, and/or concrete actions proposed by the applicant solve the identified problem? Could there be unintended consequences that might have a negative impact?
0-10 points	Feasibility: Are the other ideas, strategies, and/or concrete actions proposed by the applicant cost effective or cost prohibitive? How easy would it be to implement the other proposed actions to solve the problem?
0-5 points	Thesis statement
0-5 points	Introduction and conclusion
0-5 points	Supporting arguments
0-5 points	Research/references
0-5 points	Grammar, spelling, and punctuation
0-10 points	Overall Composition (Is the essay written well? Is it organized well? Does the essay clearly and concisely communicate the applicant’s ideas? Etc.)