Section I Committee Chair Completes Section I

Application Edward C. Bryant Scholarship for an Outstanding Graduate Student in Survey Statistics

Eligibility Requirement: You must be a full-time graduate student studying survey statistics on July 1 of the award year.

Section I - Personal Data Name:

Current Address:

Permanent Address:

Email Address:

Phone Number:

Month & year you began full-time graduate study in survey statistics University & department where you are working towards your degree Check box below that indicates what type of degree you are working towards:

MS MA Ph.D.

Section II - Education Please complete the information requested for all universities or colleges attended. Where a degree was not received, provide the semester/quarters in attendance as a full-time student. Attach additional pages if necessary. School Name & Location:

Dates Attended: Degree:

Major:

School Name & Location:

Dates Attended: Degree:

Major:

Section II – Scholastic Achievements My graduate cumulative grade point average is out of possible

Scholastics Honors (Honor Societies, Prizes, Fellowships, Scholarships, etc.):

Other Activities:

Section III – Employment History Include full-time cooperative, summer work, and research experience. Employer Name:

Employer City & State:

Dates of Employment:

Describe your responsibilities:

1 Section IV - References List the names, addresses, telephone numbers, e-mail addresses, and affiliations of the three persons providing letters of recommendation. 1st Reference Name:

Address:

Phone Number:

Email Address:

Affiliations:

2nd Reference Name:

Address:

Phone Number:

Email Address:

Affiliations:

3rd Reference Name:

Address:

Phone Number:

Email Address:

Affiliations: Section V - Personal Statement of Interests Please use a separate sheet of paper and include with this application. Write a one or two page essay about why you are studying survey statistics, and how you intend to use your graduate training in survey methods. Please feel free to supply any other information that may be helpful in assessing your application. Section VI - Authorization I authorize the circulation of the documents I have submitted, or which have been submitted on my behalf, to the members of the Edward C. Bryant Scholarship Committee. Signature: Date:

Section VII – Application Packet Checklist and Submission Deadline The following items MUST be received by March 1:  This application form  Your personal statement of interests  Original graduate transcripts  Academic reference letters from the three persons listed in Section IV of this application  CV Section VIII – Submission of Social Security Number Scholarship winners will be required to submit their social security number to the ASA in order to receive the scholarship check. Please do not email your social security number. Upon being notified that you have won, contact ASA staff liaison Pam Craven at 703-302-1860 and give her your social security number over the phone. Section IX – Where to Send Completed Application and Materials Email to [email protected]

American Statistical Association Attn: Awards Nominations 732 N. Washington Street Alexandria, VA 22314