Criteria: The Eagleson Institute sponsors this scholarship. Eligible students will be full-time, first-year students at USM with a declared major in Environmental Safety and Health.

Please note all information that is required must be provided to qualify for a scholarship. Once you have completed the application, PRINT a copy for your records and then select SUBMIT.

Application deadline is the last Friday of February.

Name Telephone

Address City

State Zip

Major Applied Medical Science Applied Technical Education Applied Technical Leadership Computer Science Engineering Electrical Engineering Mechanical Engineering Environmental Science Environmental Policy and Planning Environmental Safety and Health Industrial Technology Technical Education Other (please describe) (select major) If you selected other

Concentration Computer Engineering Construction Management Industrial Management Information and Communications Technology Precision Manufacturing (select concentration if applicable)

Class standing Freshman (0-30 credits) Sophmore (31 - 61 credits) Junior (61 to 90) credits Senior (90+ credits) Graduate (select class standing)

Expected graduation date December May August (select month) 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (year)

Total credits earned to date

Total USM credits earned to date

Grade Point Average (i.e. 3.21)

I have applied for financial aid. Yes No

This scholarship requires an essay of 500 words or less describing how you intend to contribute to the Maine community upon graduation.
Note: You can prepare the essay using wordprocessing software and then copy (text only) and paste the document into the space provided.

(Type or copy essay here)

This scholarship application requires two written recommendations, at least one of which is from a faculty member in your major department.

Please inform individuals submitting a recommendation that they can do it in one of three ways:

• The recommendation can be done within an email.
• The recommendation can be a Word or PDF document attached to an email.
• A printed recommendation can be sent or delivered to the Office of the Dean.

Submit the recommendations to:
Lori Arsenault, Administrative Manager

Office of the Dean
104 John Mitchell Center
37 College Ave, Gorham, ME 04038
207-780-5142 or larsenault@usm.maine.edu.

I understand that this application will not be considered unless two recommendations have been submitted.

Your written permission is required to publicly recognize you if you are a recipient of a scholarship award. Please indicate if you grant permission for USM to publish your name as a recipient should you be awarded this scholarship.

Yes No

The Office of the Dean will confirm by email receipt of your application. If you do not receive a comfirmation within 3 working days, contact the Office of the Dean at 207-780-5142 or larsenault@usm.maine.edu.

Email address

Retype email address