MESA UTAH SCHOLARSHIP APPLICATION

2016-2017

APPLICATIONS MUST BE COMPLETED AND

EMAILED BY FRIDAY, JANUARY 20, 2017

INSTRUCTIONS Incomplete Applications WILL NOT Be Considered!

Use a computer to complete this PDF application.

Paper application materials will not be accepted.
All transcripts and recommendations must be submitted in PDF or Word Doc format.
Include the applicants name in the PDF or Word document titles.
An official transcript must be emailed by your school registrar, counselor, or administrator.
Email at least TWO (2) current letters of recommendation. One recommendation must be from your
MESA advisor.
Email a photograph of the applicant. The photo must be in PNG or JPG format and must be
600x800 pixels in size. The file size should not exceed 2 MB.

It is important that you complete all sections of this application and clearly identify your
accomplishme nts in the afore me ntione d areas or on other attachments.

Applications, transcripts, and re comme ndations must be

sent in PDF or Word Doc format to:
mesautah@graniteschools.org

In the email subject line type:

[Applicants Name] MESA Scholarship

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Criteria

To be eligible for a scholarship you must provide evidence of:

1. Graduation from high school in 2017

2. Active MESA membership and participation in MESA program activities
3. Pursuing a degree related to Science, Technology, Engineering or Math
4. Academic achievement
5. Choice of math or science related classes
6. Extracurricular activities
7. Financial need

Scholarships are valid only at the following MESA/STEP member institutions:

Salt Lake Community College

University of Utah
Utah State University
Weber State University

If you are a financial aid recipient, scholarship monies awards must be reported to your campus Financial Aid Office as
a change in income status.

Additional information can be obtained by contacting:

Nathan Moore
MESA Utah Board Member
Department of Educational Equity
Granite School District
nmoore1@graniteschools.org

The awards reception will be in April 2017 (exact date TBA) at Weber State University. Scholarship winners will be
notified by late March 2017, in order to attend the awards reception.

Scholarship winners are REQUIRED to attend the Awards Reception.

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Students who receive a scholarship, fellowship, or other financial aid administered by the University of Utah are
required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another
country who is lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should
seek the advice of an immigration attorney before filing a scholarship/financial aid application. Prior to the
disbursement of any scholarship/financial aid, the University of Utah is required by law to verify the recipients
citizenship status or lawful presence in the U.S. with the Department of Homeland Security (DHS). Once the
University submits a students information to DHS for verification, this federal agency may have the legal right to
share the information with other government agencies. By signing this application, I certify under penalty of perjury
that I am either a U.S. citizen or a citizen of another country who is lawfully present within the U.S.

I hereby grant MESA/STEP permission to use my name and likeness in a photograph in any and all of its publications,
including website entries. I hereby irrevocably authorize MESA/STEP to use my name and to edit, alter, copy, exhibit,
publish or distribute any likeness photograph for purposes of publicizing MESA/STEP programs or for any other
lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic
copy, wherein my name and likeness appears. I have read this release and by signing the front of this application form
and I fully understand the contents, meaning, and impact of this release.

1. I agree to the above statements.

Yes

2. By typing your full name, you are providing an electronic signature.

Student Signature Parker Kvenvold
Parent/Guardian
Signature* Judith Kvenvold

*As a parent or guardian, you are required to sign acknowledging your agreement to provide income information.

3. Name
First Parker

Middle Michelle

Last Kvenvold

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4. Where will you graduate from high school?

School Academy for Math, Engineering, and Science

District AMES

5. Recommended by
MESA Advisor Kari Gardner

6. Current Address
Street & Apt # 5498 South Morning Breeze Drive

City Kearns

State Utah

Zip 84118

7. Permanent Address
Street & Apt # 5498 South Morning Breeze Drive

City Kearns

State Utah

Zip 84118

8. Date of Birth
MM DD YYYY
Date / Time 03 / 30 / 1999

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9. Gender

Female Male

10. Ethnicity
African American/Black Middle Eastern Alaskan Native/American Indian

Hispanic/Lanino(a) Bi-Racial Caucasian/White non-Hispanic

Asian Pacific Islander/Polynesian

11. Email Address

pkvenvold.ames@gmail.com

12. Primary Phone Number

801-879-4270

13. Secondary Phone Number

801-558-9476

14. Your gross annual income ($)

1734

15. Your parents gross annual income ($)

176,000

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How much financial assistance do you currently have or anticipate for the upcoming school year (from other
received scholarships, parents, etc.)?

16. Scholarship #1 (Leave blank if not applicable.)

Scholarship Name

Amount ($)

17. Scholarship #2 (Leave blank if not applicable.)

Scholarship Name

Amount ($)

18. Scholarship #3 (Leave blank if not applicable.)

Scholarship Name

Amount ($)

19. Parents/Other #1 (Leave blank if not applicable.)

Funding Source

Amount ($)

20. Parents/Other #2 (Leave blank if not applicable.)

Funding Source

Amount ($)

21. Parents/Other #3 (Leave blank if not applicable.)

Funding Source

Amount ($)

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22. Are you a US citizen?

Yes No. I am a permanent resident No. I am not a citizen and I am
not a permanent resident.

23. High School Grade Point Average

Overall GPA 3.679
Calculated Math/Science
GPA 3.4

24. What are your career choices? (Rank in order of preference.)

1st Choice Biomedical Engineer

2nd Choice Microbiologist

3rd Choice Pathologist

25. What do you plan to major in at college/university?

1st Choice Biomedical Engineering

2nd Choice Engineering

26. Name of college/university you plan to attend

Salt Lake Community College Utah Sate University

University of Utah Weber State University

Other (please specify)

27. Date of expected graduation from College/University

MM DD YYYY
Date / Time 06 / / 2021

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List any jobs / internships you have held in the last (2) years.

28. Job/Internship #1 (Leave blank if not applicable.)

Employer Mimis Cafe

Job/Title Host

Dates 01/14/2016-Present

Hours/Week 20

29. Job/Internship #2 (Leave blank if not applicable.)

Employer Mimis Cafe

Job/Title Prep Cook

Dates 06/15/2016

Hours/Week 20

30. Job/Internship #3 (Leave blank if not applicable.)

Employer Childrens Center

Job/Title Volunteer

Dates 06/09/2016-08/16/2016

Hours/Week 6

31. Job/Internship #4 (Leave blank if not applicable.)

Employer

Job/Title

Dates

Hours/Week

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In the space below provide an Extracurricular Activities List.

List your volunteer experience, academic honors, awards, special achievements, leadership positions, committees on which you
have served, and other extracurricular activities.

32. Extracurricular Activities List

Editor-in-Chief of Literary Magazine- 2013 to 2015

Varsity Tennis (Kearns)- 2013
Varsity Tennis (Cottonwood)- 2016
Jazz Band- 2013
HOSA- 2016 to 2017
Service Club- 2016 to 2017
Tennis Club- 2015 to 2016
Elder Care- 2014
Dance Club- 2015 to 2016
Excellence in Astronomy- 2014
High Honor Roll- 2013 to 2015
Tutoring for Anatomy and Physiology/ Physics
Science Fair- 2015 and took third and received the best human study

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On the following page, provide a one-page personal statement.

Content of the Personal Statement

Tell something about yourself that is not already reflected elsewhere in this application.
Comment on the obstacles you have overcome including economic, educational, social,
cultural, and other factors, which have affected your pursuit of education.
How have these factors influenced your career choices?
Also include in narrative form your volunteer involvement in school, community, MESA,
and other organizations. Tell what you contributed and gained from your involvement in
these activities.

This statement is very important to the selection committee have someone else read over it
before submitting.

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33. Personal Statement

I live in Kearns and attended Thomas Jefferson Junior High School which feeds into Kearns High
School. Kearns High School is a low-income school which fails the State school grading system
every year. Most kids who attend Kearns High School dont have a post-high school plan and
dont have the financial stability to pay for their school fees. As someone who was planning on
having to go to Kearns High School, I was skeptical on whether I would be worth anything coming
out of there, because despite being accepted into the Gifted and Talented program, I didnt feel
as though I was learning to think for myself. I also wondered how I would even be able to finance
college when scholarships are not often handed out to students in the area. My sister did not
attend Kearns High School because of its reputation, which gave me the idea to look for other
options. I found the Academy for Math, Engineering, and Science online and quickly read through
the kinds of resources they had there. I was sure that this was something that I would be
interested in due to its partnership with the University of Utah, and the ability they had to take kids
from low-income areas and give them a chance.
I enjoy helping my community which is why I volunteered at the local Childrens Center, sitting in
as an aide to Therapeutic Preschool. This gave me a chance to help parents in the community,
whilst also learning a lot about early childhood development. Overall, the experience I walked
away with made me a more patient and understanding person, due to all of the different stories
and people I encountered during my time there. I also assisted my neighbor with watching over
her elderly mother who suffered from cancer and Alzheimers. I did this by sitting with her mother
and ensuring her diet requirements were being fulfilled, but also that she was able to shower, and
participate in her mental assignments which were used to monitor her deterioration. This time
spent with her lead me to complete a research/science project in the school science fair about
how to stop the progression of Alzheimers, which I entered into the school science fair and won
Best Human Study. My volunteer work continues into my senior year, as I am involved in HOSA
and Service Club. In the month of November, I lead the club members in a fundraiser and service
project for homeless youth and veterans. We raised over $1,000 in donation money, and also
made care kits. These kits included lip balms, blankets, and hats (all of which members and I
made), gift cards and toiletries. This service project stemmed from how many homeless kids I see
in my neighborhood, and though I will never understand what that is like as a youth, it made me
come to realize that a lot of the stresses I faced from school were nothing close to what they went
through every day.
Ive also participated in varsity tennis at Cottonwood High School and Kearns High School, whilst
being involved in Literary Magazine as the Editor-in-Chief and, since the middle of junior year,
holding a part time job at Mimis Caf as a host and a prep cook. I began working, because my
parents have always had a sort of laissez-faire way of handling me. From a young age, my
parents always made sure I was taken care of as far as shelter, food, and water, but they made it
clear that I was not receiving financial help from them. When I started working, I took up paying
for my own transportation and managing my own appointments and schedule. Despite all the
effort, I still had to use their information on my FAFSA, so I did not receive any financial aid and
would not be receiving any compensation from them.

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