NSF S-STEM Scholar Information and Release Form

Name * Required
First Last
Date of Birth - must be mm/dd/yyyy format * Required
MM slash DD slash YYYY
Email * Required
Permanent Address: * Required
Street Address Address Line 2 City State ZIP Code
School Residential Address (if different from above):
Street Address Address Line 2 City State ZIP Code
Demographic Information:
Gender (check only one): * Required
- Male
- Female
- Do not wish to provide
Ethnicity (check only one): * Required
- Hispanic or Latino
- Not Hispanic or Latino
- Do not wish to provide
Race (check all that apply): * Required
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White
- Do not wish to provide
Disability (check only one): * Required
• Deaf or serious difficulty hearing • Blind or serious difficulty seeing even when wearing glasses • Serious difficulty walking or climbing stairs • Other serious disability related to a physical, mental, or emotional condition
- No
- Do not wish to provide
- Yes (check yes if any of the following apply)
Intended Major at BOISE STATE UNIVERSITY (check only one): * Required
- Astronomy
- Biological Sciences
- Biology
- Biotechnology
- Chemistry
- Computer Information Science
- Computer Science
- Computers
- Engineering – Aerospace
- Engineering – Biological
- Engineering – Biomedical
- Engineering – Chemical
- Engineering – Civil
- Engineering – Computer
- Engineering – Electrical
- Engineering – Industrial
- Engineering – Mechanical
- Engineering – Nuclear
- Engineering – Petroleum
- Engineering – Technology
- Engineering (general)
- Environmental Sciences
- Geosciences
- Materials Science
- Mathematical Sciences
- Mathematics
- Physical Sciences
- Physics
- Technology – Chemical
- Technology – Information
- Technology – Manufacturing
- Technology (general)
Degree Program (check only one): * Required
- Associate’s
- Bachelor’s
- Master’s
- Doctorate
Class (check only one): * Required
- Freshman (<25 credits)
- Sophomore (26 - 57 credits)
- Junior (58 - 89 credits)
- Senior (>90 credits)
- Graduate Student
Do you work while enrolled in school? * Required
- Yes
- No
If you selected yes, how many hours on average per week during the term?
What is your career goal? * Required
Release of Information: * Required
- By checking the box, I certify that the information contained in this form is true. I also give my permission for all information in this form as well as the relevant information in my BOISE STATE UNIVERSITY record, including transcript and entrance information, to be available to my S-STEM advisors for the purpose of reporting to NSF and determining continuing eligibility for this scholarship. I realize that NSF or its agents may contact me to request further information for the purposes of evaluation of the S-STEM program, but that I am not required to participate. I also understand that this form will become a part of my official student record at BOISE STATE UNIVERSITY.
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NSF S-STEM Scholar Information and Release Form

Demographic Information:

BIOMOLECULAR RESEARCH CENTER