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Legal Residence Information


Mailing Address for Your State (or Territory) of Legal Residence

For your state of legal residence, what is your U.S. Congressional House District. (If you do not know your congressional district, go to Enter your ZIP code to search for your Congressional Representative and his/her district. All non-voting delegations such as American Samoa, District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands should enter “At Large” for this question.)

Is your state of legal residence that same as your permanent residence? (Usually the address of your parent/legal guardian.) If no, please provide your permanent residence mailing address.

Permanent Telephone Number (Usually the phone number of a parent/legal Guardian)

If your state of legal residence is not the same as your permanent residence (parent/legal guardian), please indicate how your state of legal residence has been established.

Career Goals/Professional Aspirations

In one or two sentences, describe your career goals and professional aspirations. (200 characters)

Expand on the above brief statement to more fully describe your career goals and professional aspirations. Indicate which area(s) of mathematics, science or engineering you are considering pursuing in your research career and specify how your current academic program and your overall educational plans will assist you in achieving your career goals and professional aspirations. (3000 characters)

Describe an activity or experience that has been important in helping shape or reinforce your desire to pursue a research career in science, mathematics or engineering. (1500 Characters)

(Optional. Answering this question will depend on your personal experience.) Goldwater Scholars will be representative of the diverse economic, ethnic, racial and occupational backgrounds of families in the U.S. Describe any social and/or economic impacts you have personally experienced that have influenced your education – either positively or negatively – and describe how you dealt with them. (1500 Characters)

Research Activities (Repeat up to 5 times)

Research Activity

Starting Month and Year


Ending Month and Year

Average Hours/Week (Academic Year)

Average Hours/Week (Summer)

Name of Project Mentor (list up to 3)

Mentor’s Title

Description of the research project (1000 characters). Include a discussion of your role in and contributions to the research and the skills you acquired by working on this project.

Publication Citation(s)

Presentation Citation(s)

Absence of Research Experience

In the absence of formal research experience, describe any skills or accomplishments significant and relevant to this application (e.g., analytical, lab, presentation skills).

Activities/Accomplishments (List up to 5)


Scope of Activity/Accomplishment (i.e., international, national, college, community, other)


Leadership Position

Length of Involvement

Recognitions (List up to 5)


Type (i.e., international, national, college, community, other)

Award Description (250 characters)

Award Year

Current College/University

Institution Type (i.e., 2-year or 4-year)

Field of Study

Area of Specialization within Field

Official cumulative unweighted GPA (based on a 4.00 scale and reported to two decimal places)

How many credit hours does your school require for

How many credit hours will you achieve as of January 1, 2019?

How many credit hours do you plan to achieve for graduation?

Expected baccalaureate graduation month?

Expected baccalaureate graduation year?

According to the Goldwater definition of sophomore and junior status, indicate whether you are a sophomore or a junior. (A sophomore is an undergraduate who has two more years (4 semesters) of full-time undergraduate study left beginning September 2019. A junior is an undergraduate who has one year (2 semesters) of full-time undergraduate study left beginning in September of 2019.)

Matriculation status at the institution you will be attending during the 2019-2020 academic year.

Have you been involved in or do you plan to Study Abroad?

If yes, study Abroad Academic Institution

If yes, describe how your Study Abroad experience is relevant to your career aspirations.

Coursework (List up to 6 in each category) (If a Double Major, list courses from both majors, as appropriate.)

Current Courses (In Major)

Future Courses (In Major)

Future Courses (Outside Major)

Previous Schools Attended (if applicable)

Previous school

Official School Name



Institution Type (i.e., 2 year or 4-year)

Dates Attended

Unweighted GPA on a 4.00 scale

Will you be providing a transcript from this school to your Campus Representative?

Future Academic Plans

Is the institution you will be attending for the 2019-2020 academic year the same as your current academic institution?

What is the highest degree you plan to obtain?

If you are planning to attaining a M.D., MD/Ph.D., D.O., D.O./Ph.D., D.V.M. or D.V.M./Ph.D. degree, explain why a medical or veterinary degree is necessary for you to achieve your research goals? (2000 characters)

Certification and Release

Electronic Signature

Other Materials:

Research Essay

Names and Emails Addresses for 3 Recommenders


If a Permanent Resident, provide a copy of your permanent resident card and a letter of intent to become a U.S. citizen