Form

ENGINEERING & SURVEYING

Scholarship Application

Career & Technical Education

APPLICATION REQUIREMENTS:

The scholarship recipient must be enrolled in the engineering program at UCC during fall term 2013.

The scholarship recipient must be present at the 2013 Explore Engineering and Surveying Event, Thursday, January 31, 2013, from 6 to 8pm, in the Danny Lang Teaching & Learning Center on UCC’s main campus.

The scholarship recipient must submit a completed application prior to the end of the 2013 Explore Engineering and Surveying event. Applications may be submitted:

- By accessing the application online athttp://www.umpqua.edu/ees2013

- By sending an e-mail containing the completed application to cte.office@umpqua.edu

- In person at the 2013 Explore Engineering and Surveying Event

Please contact Ashlie Miller at 541‐440‐4605 or cte.office@umpqua.edu with any questions.

Name*

Prefix First Name Middle Initial Last Name Suffix

Mailing Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

E-mail Address*

Using a minimum of 250 words, explain why you are interested in an engineering and/or surveying career.*

Upload supporting documents here.