First Name: *

Last Name: *

Student ID#: *

Address (Street 1): *

Address (Street 2):

City: *

State: *

Zip: *

Phone #: *

*We may send text messages to this number with information relating to this scholarship application.

Paine Email Address: *

GPA: *

Credits Earned: *

Classification: * Junior
Senior

This scholarship includes the opportunity for you to serve as a Research Assistant (RA) or a Teaching Assistant (TA). Which position would you like to hold and why (100 word max)? * Note: RA and TA positions will be officially assigned after scholarships are awarded in accordance with faculty mentor availability. If currently conducting research (on or off campus), please explain in detail to assist in faculty mentor assignment. *

Scientific or Business Interest Essay

Write an essay that explains your scientific or business interest and what type of knowledge and/or skills you would like to develop as a Paine ADP Scholar. (500 word max).

OR upload an essay you have saved on your computer (500 words max):

Biographical Sketch

Please provide us a biographical sketch that includes your experience related to your education at Paine College and your particular area of study. Biographical Sketch should include these headings: 1. Career Aspirations; 2. Academic Achievements and Honors; 3. Notable Service (internships etc.); 4. Plans for Graduate or Professional School; 5. Motivational Quote (this may be a famous quote, a statement you live by, a quote you made up yourself, a motivating quote you can relate to – this quote will appear in the ADP brochure at the end of the program). (500 word max):

OR upload a sketch you have saved on your computer:

Academic References

At least TWO Academic References are required.

Reference

Name: (first, last)

Job Title:

Phone #:

City, State & Zip:

Email Address:

Recommendation Letter:

If you do not have an electronic copy of the Recommendation Letter, mail the paper document to:

Attn: ADP Scholarship Application [YOUR NAME HERE]
Paine College
Office of Sponsored Programs – HHH Room 418
C/O Geno Clark
1235 Fifteenth Street
Augusta, GA 30901

If you have questions or concerns please contact us using the information below:

Phone: 706-396-8118
gclark@paine.edu

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By clicking “SUBMIT” on this application form, I authorize Paine College to release any relevant scholarship eligibility criteria information to ADP, Inc. if or when it is requested by the grant sponsor.

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