KSU-Toyota Scholarship Application Name* First Middle Last Date* GenderFemaleMaleRace and EthnicityWith which race and ethnic backgrounds do you most closely identify?Date of Birth* Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*AdairAllenAndersonBallardBarrenBathBellBooneBourbonBoydBoyleBrackenBreathittBreckinridgeBullittButlerCaldwellCallowayCampbellCarlisleCarrollCarterCaseyChristianClarkClayClintonCrittendenCumberlandDaviessEdmonsonElliottEstillFayetteFlemingFloydFranklinFultonGallatinGarrardGrantGravesGraysonGreenGreenupHancockHardinHarlanHarrisonHartHendersonHenryHickmanHopkinsJacksonJeffersonJessamineJohnsonKentonKnottKnoxLaRueLaurelLawrenceLeeLeslieLetcherLewisLincolnLivingstonLoganLyonMadisonMagoffinMarionMarshallMartinmasonMcCrackenMcCrearyMcLeanMeadeMenifeeMercerMetcalfeMonroeMontgomeryMorganMuhlenbergNelsonNicholasOhioOldhamOwenOwsleyPendletonPerryPikePowellPulaskiRobertsonRockcastleRowanRussellScottShelbySimpsonSpencerTaylorToddTriggTrimbleUnionWarrenWashingtonWayneWebsterWhitleyWolfeWoodfordEmail Address* Main Phone Number*Secondary Phone NumberAre you a US citizen?*YesNoWhat is your intended major?*What is your average cumulative Grade Point Average?*Please enter a value between 0.000 and 5.000.Have you taken the American College Test (ACT)?*YesNoACT Date ACT Composite ScorePlease enter a value between 0 and 36.Highest ACT Mathematics SubscorePlease enter a value between 0 and 36.Highest ACT English SubscorePlease enter a value between 0 and 36.Have you taken the Scholastic Aptitude Test (SAT)?*YesNoSAT Date SAT Composite ScorePlease enter a value between 0 and 2400.Highest SAT Mathematics SubscorePlease enter a value between 0 and 800.Highest SAT Reading SubscorePlease enter a value between 0 and 800.Highest SAT Writing SubscorePlease enter a value between 0 and 800.When do you expect to enroll at Kentucky State University?*FallSpringWhat year do you expect to enroll?*20162017201820192020What high school did you attend?*High School Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country High School Phone Number*Applicant QuestionnaireWhat type of engineering degree do you plan to pursue?*Have you participated in any engineering programs in high school?*YesNoIf yes, what were they?How would you describe your family’s support of your pursuit of an engineering degree/career?*Please list any extracurricular activities in which you were involved during high school and any leadership roles you held.*Please list any community service you have participated in and your role.*Please list any part-time jobs and dates of employment.*What best describes your feelings on change?*Change makes me uncomfortable and fearful the new way won’t work.Even if it is working well, I like to look for a better way.If it works why change it?When there is a problem with a project at work, school or home do you prefer:*To figure it out myself. It’s my project and my problem.To ask someone for help.To work on something else and hope the problem fixes itself.Would you rather:*Spend your time designing parts for the vehicle?Spend your time on the manufacturing floor solving problems? To ask someone for help.Give an example of a time you were problem solving with a team and there was a conflict or disagreement. Explain how you handled it. What was your contribution to coming to a resolution?*Essay SubmissionAs part of this scholarship application, you are required to submit a typed essay (1000 words or less) expressing why you are deserving of this opportunity and why you will succeed. You can submit this essay in the text box below or you can upload it below. You may also mail it in to Kentucky State University, Office of Academic Affairs, Hume Hall, Suite 202, 400 E Main Street, Frankfort, Kentucky 40601.Copy and paste your essay here:Or upload your essay here.Accepted file types: pdf, doc, docx, odt, ods, odp, rtf.Signature*ALL APPLICANTS MUST COMPLETE THIS SECTION. I declare and certify that I have examined the information in this application and that, to the best of my knowledge, it is complete and accurate. If awarded the Kentucky State University and Toyota Academic Scholarship, I will major in and do my best to complete an Engineering degree program in Applied Engineering or related engineering field. I authorize school officials (KSU and others) to release to the Kentucky State University Division of Mathematics and Sciences and Toyota any information pertinent to this application.