<p> Bluemke Science and Engineering Scholarship Application</p><p>Student ID# Last First Middle</p><p>Address</p><p>City State Zip Code</p><p>Home Telephone Number Cell Phone</p><p>Cumulative Grade Point Avg. Class Rank # in Class</p><p>TEST SCORES ACT E M R S Writing Composite</p><p>SAT V M Writing</p><p>INTENDED COLLEGE MAJOR: Scholarship applies to University of Wisconsin campuses only. Scholarship is for tuition only. UW CAMPUSES UNDER CONSIDERATION:</p><p>#1 Tuition</p><p>#2 Tuition</p><p>#3 Tuition</p><p>LIST YOUR EXTRA-CURRICULAR INVOLVEMENT: (include leadership positions) Activity Grade</p><p>1.</p><p>2.</p><p>3.</p><p>4. LIST ATHLETIC PARTICIPATION: Sport Grade</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>COMMUNITY INVOLVEMENT: Dates of Activity Participation</p><p>1.</p><p>2</p><p>3</p><p>LIST ANY HONORS AND/OR AWARDS:</p><p>Honors//Awards Grade</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>WORK EXPERIENCE</p><p>Employer Grade</p><p>1.</p><p>2.</p><p>3. SCHOLARSHIPS AWARDED:</p><p>Name of Scholarship Amount</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>ESSAY: </p><p>Why do you want to study science, engineering and/or mathematics? What do you think this degree will do for you?</p><p>Return applications to Ms. Reisenauer in Student Services by 3:00 p.m. on Monday, March 19, 2018. Financial Need Confidential Information Financial information may or may not be used in the qualification process. Please obtain your parent’s permission to give the following information.</p><p>FAMILY DATA Father’s Name Age Address Employed by Occupation Annual Income Mother’s Name Age Address Employed by Occupation Annual Income OTHER INCOME</p><p>Does the family own its home? Other Property?</p><p>Please list the number of brother and sisters and their ages: Siblings Name Age Siblings Name Age Siblings Name Age Siblings Name Age</p><p>Colleg # of children now attending: High School Middle School Elementary</p><p>Are there other circumstances that would make it difficult for the family to provide as much funding for college as they otherwise might be able to provide? Please describe below (medical expenses, employment problems, etc).</p><p>Signature of Parent / Guardian Date</p><p>Student’s Name</p>