Thank you for your interest in the Justin Chlebus Memorial Scholarship. Please review the application and consider it carefully before deciding whether or not to apply. If you do choose to apply, it is important that you invest the time and effort necessary to fully communicate who you are, as well as the degree to which you have achieved proficiency in your chosen field.
Application form for the Justin Chlebus Memorial Scholarship.
Note: Required questions are indicated with a *
Contact information
* First name
* Last name
* Email address
* Phone number
* Mailing address
* Date of birth
* Self-introduction

Please introduce yourself. Who are you? What is your approach to life? What are your career goals?
Academic career
* Home institution


Which university do you currently attend?
* Class standing

What will your class standing be at the time of departure for this program?
* Major
What is your primary field of study?
Minor
(if applicable)
* GPA
What is your current grade point average?
Study abroad
* Study abroad program

Please tell us about the study abroad program in which you plan to participate.
* Semester of study
When do you plan on studying abroad?
Written portion
* Unique skill or ability

To earn a grant under this program, an applicant must have exceptional ability in one of the sciences (programming, engineering, research, etc.) or arts (music, dance, literature, graphic arts, etc.) In what field do you excel? What have you accomplished in that field? What do you love about this field, and what is your goal in it?
* Language interest

Under the program, the award recipient(s) will spend one semester (minimum of 4 months) to a year in a country in which a language foreign to them is spoken. They are expected to devote themselves to learning that language in the time that is available to them. Please describe your interest in learning another language.
* Country of study

Please indicate in which country you plan on studying, why you are interested in studying there, and how you seek to practice your art/science/skill in that country. Please also indicate your current level of proficiency in the language of that country.
* Long-term contribution

Ultimately, what do you hope to contribute to the world through your life and art / skill? How would this program help you to do that?
Additional information

If you have a link to your work in text, graphic, or video form, please include that here.
There is no preview step in the form submission process. Please double-check your application before submitting.