HBCU Week x The Future of STEM Scholars Initiative

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Page 1

Scholarship Eligibility

	Yes	No
Are you a U.S. citizen or legal permanent resident of the United States?
Are you a high school senior?

To be eligible for the scholarship, you must be a U.S. citizen or legal permanent resident of the United States.

To be eligible for the scholarship, you must be a current high school senior.

High School Grade Point Average (GPA) on a A 4.0 Scale (unweighted) Please round to the nearest tenth (e.g., 2.95 and higher round up to 3.0)

*If GPA is weighted, please convert your weighted GPA to unweighted. Seek high school counselor’s advice on how to convert unweighted GPA * REQUIRED PROOF OF GPA: YOUR MOST RECENT OFFICIAL SCHOOL TRANSCRIPT--A Minimum of 3.0 IS REQUIRED

*To be eligible for the scholarship, you must have a 3.0 or higher GPA.

	Yes	No
Are you planning to pursue a career in medicine or social sciences?

You are not eligible to apply for this scholarship and can not proceed.

Students pursuing careers in nursing, medicine, veterinary studies, psychology, social sciences and other associated fields do not qualify for FOSSI. Some fields of study which may be generally considered as STEM may not qualify for FOSSI scholarships. FOSSI scholars must have an approved FOSSI major throughout their 4 years of college to retain their scholarship.

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Student Information

First Name

Last Name

Gender

Gender Other

Mailing Street

Mailing City

Mailing County

Mailing State

Mailing Zip/Postal Code

Mobile Phone

Personal Email

	Email	Phone
What's the best way to contact you?

Birthdate

Age

How did you hear about the scholarship?

Other

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Daytime Phone

Parent/Guardian Mailing Address

Parent/Guardian Mailing City

Parent/Guardian Mailing State

Parent/Guardian Mailing Zip/Postal Code

Parent/Guardian Relationship to Applicant

High School Information

High School Attended

	1	2	3	4
Number of years attended

High School City

High School State

I will be attending the following school in Fall of 2027

	Yes	No - Undecided
Do you know what school you plan on attending?

Intended HBCU

I will be attending the following school in Fall of 2026

	Yes	No - Undecided
Do you know what school you plan on attending?

HBCU School State

Alabama Schools

Arkansas Schools

California School

Delaware School

District of Columbia Schools

Florida Schools

Georgia Schools

Kentucky Schools

Louisiana Schools

Maryland Schools

Mississippi Schools

Missouri Schools

North Carolina Schools

Ohio Schools

Oklahoma School

Pennsylvania Schools

South Carolina Schools

Tennessee Schools

Texas Schools

US Virgin Islands School

Virginia Schools

West Virginia Schools

Statement of Financial Need

Provide a brief overview of your financial situation. Include information that may be helpful in understanding challenges for funding your school career. Describe how receiving this scholarship would impact your ability to achieve your future STEM aspirations. Note: This should not be a personal statement, and focus only on your financial situation.

	Yes	No
I attest that I am in need of financial assistance for my college expenses

Household Income

Please provide a Statement of Financial Need

(200 word maximum)

Intended STEM Major

Engineering (Other)

Funded by the chemical and related industries, FOSSI is dedicated to building a strong pipeline of scientists and engineers prepared to shape the future of these sectors. By supporting HBCU students pursuing degrees in industry-aligned majors, FOSSI helps develop the talent needed to drive innovation, strengthen manufacturing, and address complex challenges throughout the chemical industry.

To remain focused on this mission, FOSSI supports majors that directly align with the workforce needs of its sponsoring industries. Fields outside the program’s scope include architecture, aerospace engineering, sound or audio engineering, bioengineering, medicine, dentistry, psychology, the social sciences, and related disciplines.

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ACKNOWLEDGMENT AND RELEASE

I have read and understand the criteria and requirements and agree to all. I understand that lack of fulfillment of these criteria may result in loss of the award.

As a condition of scholarship receipt, I give permission to HBCU Week Foundation to use my name, photos, video imagery, video audio, interview content and other materials about me for promotional, publicity, marketing, or organizational purposes.

PARENT/GUARDIAN SIGNATURE IS REQUIRED ON THE FOLLOWING PAGE.

Page 5

Parent / Guardian Consent & Authorization

Parent or Legal Guardian Full Name

Electronic Signature Statement

I certify that I am the parent or legal guardian of the applicant. I have reviewed this application, confirm that all information provided is accurate, and give full permission for the student to apply for this scholarship.

Date Signed

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