Form Signature Test

Name*
First Last
Address*
Street Address City State ZIP Code
Home Phone
Cell Phone*
Email*
Enter Email Confirm Email
Are you a United States Citizen?*
Do you have a U.S. Permanent Residence Visa?*
Are you a previous recipient of a GUAALA Scholarship?*
If you are a previous recipient, please provide the previous dates of the awards:*
Educational Information:
High School*
High School GPA*
High School Graduation Date*
College GPA
College Major
Extracurricular Activities
Activity #1*
Roles & Responsibilities of Activity #1*
Activity #2
Roles & Responsibilities of Activity #2
Activity #3
Roles & Responsibilities of Activity #3
Activity #4
Roles & Responsibilities of Activity #4
Activity #5
Roles & Responsibilities of Activity #5
Employment or Volunteer Services
Essay Question*
In 500 words or less, explain why you have chosen GSU as your institution of higher learning, and how you believe your education, experiences, etc., there will be of value to you as an individual, your immediate family, community and the world at large. (If additional space is needed, please submit a separate attachment.)
References
Reference #1
Name of Reference #1*
First Last
Phone Number of Reference #1*
Email Address of Reference #1*
Address of Reference #1*
Street Address City State ZIP Code
Reference #2
Name of Reference #2*
First Last
Phone Number of Reference #2*
Email Address of Reference #2*
Address of Reference #2*
Street Address City State ZIP Code
Reference #3
Name of Reference #3*
First Last
Phone Number of Reference #3*
Email Address of Reference #3*
Address of Reference #3*
Street Address City State ZIP Code
PLEASE READ BEFORE SIGNING:
By signing this application, I understand that if awarded funds by the GUAA-LA Scholarship Committee such funds are subject to the policies and regulations of the Committee. Any false statements or misrepresentation made by me on this application or any supplement will be sufficient grounds for immediate cessation of funds. I also understand that as a recipient of this scholarship, I must maintain a GPA of 2.5 or higher each semester; I also agree to communicate with the Alumni Association (AA) at regular intervals during the school year; To the degree possible, I agree to participate in activities sponsored by the AA and the annual Historical Black Colleges and Universities (HBCU) picnic held in Los Angeles in August of each year; I understand that the amount of my scholarship will be based on available funds; I understand that it is my responsibility to provide the Scholarship Committee with my current home address, telephone number, email address, and an official or unofficial copy of my transcript along with proof of enrollment within the first 30-days of each semester; and I understand that my parent(s) and/or guardian(s) will be invited to become Associate members of the Alumni Association and are expected to support the Association’s local fundraisers.
Applicant’s Name*
Photo of Applicant
Accepted file types: jpg, jpeg, png, pdf.
Please upload a photo of applicant in JPG, PNG, or PDF file format. Maximum file size is 5mb.
Applicant Signature
Use your mouse cursor on a desktop of notebook computer, or finger on touchscreen, to sign.
Applicant Signature Date
Parent/Guardian Name*
Parent/Guardian Signature
Use your mouse cursor on a desktop of notebook computer, or finger on touchscreen, to sign.
Parent/Guardian Signature Date

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Educational Information:

Extracurricular Activities

References

Reference #1

Reference #2

Reference #3

PLEASE READ BEFORE SIGNING: