PERSONAL DATA

Your Name:

Your Email:

Address 1:

Address 2:

City:

Zip Code:

Telephone Number:

Birthdate

Birthplace :

Mother’s Name :

Mother’s Occupation :

Father’s Name :

Father’s Occupation :

EDUCATION

High School :

What is the Base of the Cumulative Grade Point Average at your School? (i.e., What number does “A” represent?)
:

Cumulative GPA :

Graduation Date :

ACTIVITIES

High School Activities, Hobbies & Community Service
:

List below you involvement in any clubs, honorary societies or community service organizations
(List Office Held and Name of Organization)

CAREER GOALS - (answer all questions in 200 words or less)

What is your particular interest in the field covered by ASHRAE?
:

To what extent have you participated in activities related to fields covered by ASHRAE?
:

Why should we award this scholarship to you? Please justify financial need.
:

REFERENCES (Please list two names and addresses)
Teacher

Name:

Email:

Address 1:

Address 2:

City:

Zip Code:

Telephone Number:

Other

Name: :

Email:

Address 1:

Address 2:

City:

Zip Code:

Telephone Number:

IMPORTANT: An official transcript of all high school grades and reference letters must be submitted in one package
and returned to the high school counselor on or before the application deadline before your application can be
considered. Submit only one application.

I confirm that I believe all the above information to be true and complete and I hereby apply to the American Society of Heating, Refrigeration, and Air-Conditioning Engineers, Inc. for an ASHRAE Scholarship. I certify that I am not receiving full funding for my education from an employer, any branch of the Armed Services or other organization. I authorize ASHRAE to obtain and review my academic records (including nut not limited to official transcripts). By checking this box, I agree to hold ASHRAE harmless from any and all liability for damage, injury, or loss sustained by me in connection with this application, including but not limited to, the acquisition by ASHRAE of my academic records.