Mark Jacob Van der Merwe

Personal Information

Date Submitted:

Mark Jacob Van der Merwe

State Student ID:

2041562

3483 Arcata Road

Date of Birth:

04/11/1998

Salt Lake City, Utah 84124

Gender:

Male

Ethnic Origin:

White

U.S. Citizen:

Yes

I have a criminal record?

No

(848) 200-0884

12/02/2015

vandermerwem2@gmail.com

Education Information
Which high school will you graduate Academy for Math, Engineering and
from?
Science (AMES)

ACT Test Scores

Are you graduating in the 2015-16

school year?

Yes

ACT Test Date:

06/13/2015

Composite:

35

Which grade will you be in when

you graduate?

12

English:

35

Cumulative High School GPA:

4.000

Math:

35

Reading:

35

Science:

34

Which Utah college or university do

University of Utah
you plan on attending?

Course Information
Grade 9
Subject

Course

English

English 9

Mathematics

Secondary Math 1 H

Social Science

Human Geography AP

Science

Biology H

World Language

Spanish 2

School
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)

Grades

Credit

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

Grades

Credit

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

A,A,A,A

1.00

Grade 10
Subject

Course

English

English 10

Mathematics

Secondary Math 2 H

Social Science

European History AP

Science

Chemistry H

World Language

Spanish 3

School
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)

Grade 11
Subject
English

Course

School

Grades

Credit

English 11

Academy for Math, Engineering and

Science (AMES)

A,A,A,A

1.00

Subject

Course

Mathematics
Social Science
Science

Science

School

Academy for Math, Engineering and

Secondary Math 3 H
Science (AMES)
Academy for Math, Engineering and
US History AP
Science (AMES)
Academy for Math, Engineering and
CHEMISTRY 1210/1215 Gen Chem 1
Science (AMES), University of Utah
Academy for Math, Engineering and
CHEMISTRY 1220/1225 Gen Chem 2
Science (AMES), University of Utah
Academy for Math, Engineering and
Physics H
Science (AMES)

Grades

Credit

A,A,A,A

1.00

A,A,A,A

1.00

A,A

1.33

A,A

1.33

A,A,A,A

1.00

Grades

Credit

Will Complete
Subject

Course

English

English 1010 Introduction to Writing

English 2010 Intermediate Writing

Mathematics

Math 1210 Calculus 1

Math 1220 Calculus 2
Statistics AP

Social Science

US Government AP

Science

Physics 2210/2215 Scien/Engin 1

Physics 2220/2225 Scien/Engin 2

School
Academy for Math, Engineering and
Science (AMES), University of Utah
Academy for Math, Engineering and
Science (AMES), University of Utah
Academy for Math, Engineering and
Science (AMES), University of Utah
Academy for Math, Engineering and
Science (AMES), University of Utah
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES)
Academy for Math, Engineering and
Science (AMES), University of Utah
Academy for Math, Engineering and
Science (AMES), University of Utah

1.00
1.00
1.33
1.33
A

1.00

0.50
1.33
1.33

Acknowledgement Statements
I understand that by submitting this signed application I am certifying, under penalty of law (perjury), that I am a U.S. citizen or a
qualified alien who is lawfully present in the United States.
I understand it is my responsibility as the applicant to keep copies and records of documents submitted to the Regents
Scholarship office such as transcripts, ACT scores, forms and certified mail receipts.
I understand that all required documentation (listed below) must be postmarked by December 11, 2015, to meet the priority
deadline, or postmarked by February 1, 2016, to meet the final application deadline. Faxed or emailed documents are not
accepted.
Mail documents to:
Regents' Scholarship
PO Box 145114
Salt Lake City, UT 84114
1. Official high school transcript for the high school from which I will graduate. If the option is available to have your
school send the transcript through an electronic transcript exchange, we HIGHLY recommend you choose this delivery option.
2. Miscellaneous official transcripts from the original source where the course work was completed and where I earned credit
for an English, Math, Science, Social Science, Science or World Language course(s).
i) This is required if I completed courses through any schools/business entities that were outside of the school district from
which I am graduating.
This includes out-of-state schools, charter schools, online schools (excluding Electronic High School), private schools,
and business entities such as, but not limited to, Brigham Young University Independent Study and Northridge
Learning Center/Dorius Academy.
ii) This is required even if the course is reported on my high school transcript from the school from which I will graduate
because my application will be evaluated off of the information reflected on the transcript from the original source, not the
transcript that shows the transferred course work and grades.
3. Official college transcript(s) should be submitted via the university/college's electronic transcript exchange directly to our
office. If the exchange system that your university/college uses requires you to input an email for the recipient please use
regentsscholarship@ushe.edu. Transcripts emailed directly from the student to our office are not accepted.
i) These are required as part of my supporting documents if I have earned any college credit through concurrent enrollment,
distance education, or regular college/university enrollment for any English, Math, Social Science, Science or World
Language completed during grades 9, 10, and 11.

ii) Your application will be evaluated based on the college grade and credits you earned. Therefore, the official college
transcript must be submitted even if the course is reported on your high school transcript.
4. ACT scores. A copy of my score report or the ACT scores listed on my official high school transcript, if my high school
transcript includes ACT scores.
I understand that if I do not complete the courses as I have reported them on my application it may negatively impact my ability to
qualify for the Regents Scholarship. This includes completing the course from a different source than originally reported as well as
changing my schedule and not completing the course.
I understand I can use the student portal to check to see if the documents I have submitted have been received (a confirmation
that a document has been received does not mean the document has been reviewed). I understand if my documents are
submitted fewer than 10 business days prior to the deadline it will not be feasible to receive a confirmation of the receipt of the
documents prior to the deadline.
I understand that to ensure I receive accurate information I will only seek assistance from the Regents Scholarship staff.
I understand that if I have not received a notification message from the Regents Scholarship office by May 1, 2016, I am to call
the office to inquire about the status of my application or I risk forfeiting consideration for the scholarship.