Spring 2015 GDAS Application

University of Hawai‘i  Office of Public Health Studies  Department of Public Health Sciences

SPRING 2015 GRADUATE DIVISION ACHIEVEMENT SCHOLARSHIP APPLICATION The University’s Office of Graduate Education allocates a limited number of Graduate Division Achievement Scholarships (GDAS) to the Department of Public Health Sciences each semester. These scholarships are funded from tuition revenues and are intended to provide financial assistance for U.S. and international students based on merit and service. The award amounts, which vary, are credited toward the student’s overall tuition costs and/or the cost of attendance (i.e., fees, housing costs, and books can also be covered). Due to federal regulations, awards to international students can only be used for direct tuition costs and mandatory fees. International students with an assistantship, scholarship or fellowship which covers the cost of tuition are not eligible for this award. To be eligible for the department’s GDAS, students must meet the following criteria:  The prospective recipient must be a degree-seeking student in a master’s or doctoral program and have a cumulative GPA of 3.5 or above.  The student must demonstrate a commitment to the mission, goals and objectives of the Dept. of Public Health Sciences (DPHS).  Award recipients are required to enroll for a minimum of one (1) credit or more of public health degree-related courses and maintain a cumulative GPA of 3.5 or above for the entire period of the award.  The scholarship cannot be used towards Outreach College tuition.  Should the student receive a new or continuing appointment as a Teaching Assistant (TA) or Graduate Assistant (GA) with full tuition exemption for Spring 2015, the GDAS award may be automatically removed. Any requests for exception must be received prior to the TA/GA tuition exemption being entered in the student’s account. Exception requests will be handled on a case-by-case basis and does not guarantee exclusion from this GDAS award criterion. ELI courses and courses used to remedy undergraduate deficiencies are considered degree-related. Audit courses are not considered degree-related. All credits must be taken for letter grade with the exception of PH 699, which may be taken CR/NC and still count towards the degree. In addition, if you are taking courses outside of public health and wish to have these credits counted, they must be at the graduate level and approved by your faculty advisor. If you are selected to receive a GDAS, an award letter will be sent to you via email. You will be required to complete and submit an Award Acceptance Agreement to confirm you understand the conditions of the award. Upon our receipt of this form, your award will be entered in STAR—the University's scholarship disbursal system—which prevents the purging of your registration if the GDAS award is not credited towards your account prior to the initial tuition payment deadline. The GDAS award and the amount you owe for the remaining tuition and/or fees, if any, will be displayed on the “Review My Charges/Make an Online Payment” page only after the University’s Financial Aid Services completes the disbursement process. You are responsible for meeting the subsequent payment receipt deadline. An enrollment audit will be conducted after the registration period to ensure all GDAS award criteria have been met. A student whose GDAS award is rescinded will be required to reimburse the University in full for tuition costs. Please note that awards are made for the semester of application. Students will need to reapply each semester if they wish to be considered for an award. Contact the Office of Public Health Student Academic Services (OPHSAS), Biomed D-204, if you have any questions. APPLICATION DEADLINE: FRIDAY, NOVEMBER 14, 2014

THIS IS A FORM-FILLABLE DOCUMENT. Instructions for completion: (1) Input responses in shaded areas; (2) Save completed form and email to [email protected]. Submission via email preferred. Or submit printed forms to: OPHSAS, Biom D-204, 1960 East West Rd, Honolulu, HI 96822.

I. PERSONAL INFORMATION Title Name (Last, First MI) UH Username or ID# Gender Degree Sought

Specialization Area (select one)

Epi Hlth Policy & Mgmt Native Hawaiian & Indigenous Hlth Social & Behavioral Hth Sci Trans Res (DrPH only) Sem/Yr Admitted to DPHS Email Address (for notification purposes) Daytime Phone No. Admitted Fall Spring Year:

II. ELIGIBILITY Read the attached information sheet carefully for eligibility requirements. Current Residency Status for Tuition Purposes Resident Nonresident with a tuition differential Nonresident (Applying for resident status? Yes No) Number of credits you will register for in Spring 2015? Expected Graduation Date I intend to enroll for public health degree-related credits. Semester/Year: Do you have a Graduate Assistantship for Spring 2015? Yes (I will submit a request for exception via email to [email protected]) No Applying to: III. ACADEMIC BACKGROUND List colleges/universities you attended beginning with the most recent.

College/University From (m/yy) To (m/yy) Major Degree

IV. ACTIVITIES List your professional, volunteer, and relevant extra-curricular activities beginning with the most recent.

Position/Activity Title & Organization Name From (m/yy) To (m/yy) Hrs per week

V. OBJECTIVE STATEMENT Please briefly explain your academic and professional goals, the steps you have already taken towards meeting these goals, and how the Achievement Scholarship would assist you in your objectives. If your academic background requires an explanation, please provide one here as well.

My signature below attests that I have read and agree to the following: I hereby authorize the Office of Public Health Student Academic Services (OPHSAS) to release all of my transcripts and grades to the Graduate Division Achievement Scholarship (GDAS) Review Committee. In the event I am awarded a GDAS and subsequently fail to fulfill the eligibility requirements for the entire semester, I understand the award will be rescinded and I agree to repay the tuition. I will notify OPHSAS immediately should any of the following occur: change in my residency status; receipt of a graduate/teaching assistantship; receipt of a scholarship or fellowship which covers my tuition and fees cost (international students only); placed on academic probation.

Student’s Signature (type in your full name if submitting via e-mail) Date

This application does not guarantee the award of a scholarship. Contact OPHSAS if you prefer to receive the document in an alternate format (e.g., a PDF or printed copy). E- mailed applications are preferred. You should be notified before the end of this semester if you have been selected to receive an award. 10/14