APPLICATION FOR THE RAYMOND DAVIS SCHOLARSHIP SPONSORED BY

IS&T: THE SOCIETY FOR IMAGING SCIENCE & TECHNOLOGY

I hereby apply to the Society for Imaging Science and Technology for a Raymond Davis Scholarship. If
selected, I agree to pursue a course of full-time study in the field of photographic/imaging science
or engineering toward the fulfillment of the requirements for an academic degree. I agree to an
interview, if requested, and hereby authorize colleges or other institutions of higher learning I have
attended, and their faculties and staffs, to use and draw upon my educational records as necessary for
evaluation, and to send such evaluations and letters of recommendation, in confidence, to the Raymond
Davis Scholarship Committee. I certify that the information provided in this application is, to the best of
my knowledge and belief, accurate and complete.

Are you an under-graduate or graduate student? yes no

Will you have completed two academic years before the term of the scholarship? yes no

Are a student of photographic or imaging science or engineering? yes no

If you answered NO to any of the above questions you are NOT eligible for the scholarship and your
application will not be considered.

Signature Date

1. Name (Please Print)

2. Current Address

Telephone

3. Permanent Address if different than above:

Telephone

4. Educational Background. Please list the following for each undergraduate and graduate school at-
tended.
College Address Dates Dept. Head Degree
APPLICATION FOR IS&T RAYMOND DAVIS SCHOLARSHIP - PAGE 2

5. Employment Background. Please list the following for each employer.

Company Name & Address Supervisor Name Dates of Employment Description of Duties

6. Institution selected for further study:

7. Are you now enrolled or considered a full-time student at this institution? yes no

8. If not, have you applied? yes no

9. Date of application:

10. Have you been notified of acceptance? yes no

11. Major: 12. Department:

13. Degree anticipated: 14. Expected date of Completion:

15. Graduate Students: give an abstract of your plan for advance study, research and thesis.
(Attach additional sheets if necessary)

16. Outline your career objectives and indicate how the academic work you propose to undertake will
further your objectives (Attach additional sheets if necessary)

17. List names and current addresses of three persons, other than relatives or college department heads,
who are familiar with your work and able to judge its quality. (The Society may request letters of
recommendation)

REMINDER: ENCLOSE THE FOLLOWING ALONG WITH YOUR COMPLETED

APPLICATION:

1. Letters of nomination from at least two (2) faculty members.

2. An official transcript of your college record.
3. A personal letter stating your own goals and interests.

Return to: IS&T, 7003 Kilworth Lane, Springfield, VA 22151 by October 1st.