<p> DON B. OLSEN MENTORSHIP IN BIOMEDICAL ENGINEERING (Fulton College of Engineering & Technology, Brigham Young University) Please email all application materials to “[email protected]”</p><p>This mentorship will be awarded to students pursuing a degree in engineering (chemical, mechanical, or electrical) or technology and must be a U.S. citizen. Academic merit, service, and financial need will be considered in selecting the recipient.</p><p>Last Name: ______First Name: ______M.I.___ Student ID No.: ______Email Address: ______</p><p>Address where the mentorship notification could be mailed: Street: ______Apt: ______City: ______State: ______Zip Code: ______Phone: ______</p><p>Major at BYU: ______Overall BYU GPA: ______Anticipated Graduation Date: ______Plans After Graduation: ______</p><p>You are applying for the Don B. Olsen Mentorship in Biomedical Engineering for… Which academic year? ______How many credit hours do you plan to take that year (total of fall and winter semesters)? ______</p><p>Are you currently working (Y/N)? ______How many hours/week? ______</p><p>Are you married (Y/N) ? ______Number and ages of children ______If married, is your spouse a full-time student (Y/N)? ______</p><p>Do you have a Pell Grant or a Stafford Student Loan for the year for which you are seeking this mentorship (Y/N)? ______Amount? ______</p><p>List all other scholarships/loans (and their amounts) you will be receiving for the year for which you are seeking the Mentorship: ______</p><p>Essay: Attach a short essay explaining the following: 1. Your interest in biomedical engineering (with supporting evidence) 2. Your interest and involvement in research 3. How you plan to use the Mentorship research experience in your future 4. Your involvement in extracurricular and/or service activities 5. Your Financial Need (this will be the most important criterion in awarding the Mentorship). Describe factors that affect your financial need, including financial obligations and financial support (including from parents, from a non-student spouse, and from current scholarships, grants, and existing loans)</p><p>Also Complete the Back/Next Page of this Form Student Certification</p><p>I certify that the information furnished on this form is true to the best of my knowledge and that:</p><p>1. I am officially enrolled as a full-time student in the major indicated on the front of this form, and I am a U.S. citizen. 2. I will take at least 28 semester credit hours in the academic year (total of the fall and winter semesters) for which I am applying for the Don B. Olsen Mentorship in Biomedical Engineering. 3. I agree to live by the BYU honor code, including the dress and grooming standards. 4. I promise that, if awarded the Don B. Olsen Mentorship in Biomedical Engineering, … • I will write a letter of appreciation to Dr. Olsen. • I will participate in a biomedical engineering research project mutually agreed upon by myself and a faculty mentor. • If I withdraw from my major (unless changing to another major eligible for the Olsen Mentorship) before the end of the year of the award or fail to successfully complete any of the major courses for that year, I will return the tuition portion of the Mentorship. • If I fail to uphold my obligation to participate in the chosen research project in good faith and with appropriate commitment, I will return both the tuition and research portions of the Mentorship.</p><p>______Signature Date</p><p>Note: You can also turn in paper copies of this application (along with required essays) to the secretaries in the Chemical Engineering Department office, 350 CB. Digital copies (all one document please) can be emailed to [email protected].</p>