Application Form - Mississippi

If you experience any technical difficulties or see any errors with this application, please contact Ryan Ozment at rozment@mdeq.ms.gov.

Section 1 - Application

Name:

* Indicates required field

First *

Last *

Middle *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Educational Background (if necessary, provide an anticipated date for the graduate degree):

Undergraduate Degree & Major *

Graduate Degree & Major *

Date (mm/dd/yyyy) *

Institution *

Major Course of Study *

GPA *

Section 2 - Statement of Professional Goals

Upload Statement *

Max file size: 20MB

Copy and Paste or Type Statement *

This section should contain a summary statement of your professional goals. Please indicate both your preferred career after receiving your graduate degree and its relation to short- and long-term goals. Discuss your planned graduate study, relating the significance and relation between (a) course work and research and (b) professional objective(s).

There are two options for this section:

Upload the summary statement as a word processing file or a PDF file or
You may also copy and paste or type the professional goals statement in box provided.

At least one of the two options must be completed to be considered for the scholarship. Limit to a maximum of two single spaced typed pages.

Section 3 - Transcripts

Please upload a copy of your transcripts. Photocopies are acceptable.

Upload Baccalaureate Transcript *

Max file size: 20MB

Upload Higher Degree Transcript(s) *

Max file size: 20MB

Other Uploads (Transfer Transcripts, etc.) *

Max file size: 20MB

Section 4 - Verification of Graduate School Attendance

Please upload acceptable documentation that you will be attending a qualifying graduate program during the 2019-2020 academic year.

Upload Proof of Attenance *

Max file size: 20MB

Section 5 - Professional/Non-Professional Work Experience

Upload Resume *

Max file size: 20MB

Copy and Paste or Type Resume *

This section should contain a a resume of part-time and full-time work experience including dates of employment, employer, and responsibilities. You may choose to include information with respect to community participation, professional societies and association participation, professional registration/certification status, and scholarships/fellowships received.

There are two options for this section:

Upload the resume as a word processing file or a PDF file or
You may also copy and paste or type the resume in box provided.

At least one of the two options must be completed to be considered for the scholarship. Limit to a maximum of two single spaced typed pages.

Section 6 - Recommendations

Please list below two references familiar with your academic record and plans for graduate research. Letters of recommendation are required for the two references listed. Letters of recommendation may be uploaded or sent separately by the reference.

First Recommender Name *

First

Last

Affiliation *

Email *

Phone Number *

Second Recommender Name *

First

Last

Affiliation *

Email *

Phone Number *

Recommendation *

Max file size: 20MB

Recommendation *

Max file size: 20MB

For recommendations by mail, address to:
Anna Chappell
1945 Airport Road
Columbus, Mississippi 39701

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