Scholarship Application
(Departmental use optional)
Deadline Date:__________________
COMPLETE NAME OF SCHOLARSHIP/FELLOWSHIP
FOUNDATION PROJECT ID
PURPOSE/CRITERIA OF SCHOLARSHIP/FELLOWSHIP (excerpted from memorandum of understanding,
endowment agreement or other official documentation on file with the foundation)
Section A: Personal Information
NAME
DATE
Last
First
PANTHER ID NUMBER
Middle
DATE OF BIRTH (MM/DD/YY)
GENDER
_______________________
e
 Male
 Female
LOCAL ADDRESS
Street or P. O. Box
City
State
Zip
STUDENT E-MAIL ADDRESS TELEPHONE NUMBERS
Home
Cell
RESIDENCY STATUS:
 Permanent resident Other (please specify): ________________________________________
a
If you checked Other, please complete a foreign national tax analysis information form
l and attach it to this acceptance form. (The form is
available from the Office of Disbursements tax accountant.) I understand that my scholarship/award/fellowship
will be subject to review
i
by the university tax accountant and that payment from the foundation may be subject
e to tax withholding under the IRS regulations
governing payments to foreign nationals.
n
U. S. STATE OF RESIDENCE
HOME COUNTY (For Georgia
residents)
(green card holder)
 U.S. Citizen
Section B: Academic Information
For all students
ENROLLMENT STATUS
 Full-time
 Part-
 Undergraduate
time
 Graduate
CLASSIFICATION FOR _____________________(Academic Year 20xx/20xx)
 Freshman
 Sophomore
Current GPA
 Junior
Institutional GPA
 Senior
 Post Bac.
 Graduate
 Law
HOPE GPA
COLLEGE AFFILIATION:
MAJOR
MINOR
CUMULATIVE CREDIT HOURS
CONCENTRATION
For incoming freshman
HIGH SCHOOL
GEORGIA STATE UNIVERSITY FOUNDATION
Generic Scholarship Application
GRADUATION DATE
GPA
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SAT SCORE
SAT VERBAL/Critical Reading
ACT SCORE
ACT Freshman Index Score
SAT Mathematics
For Transfer students
NAME OF CURRENT SCHOOL/COLLEGE/UNIVERSITY:
TRANSFER GPA
MAJOR
INSTITUTIONAL GPA
MINOR
CONCENTRATION
Section C: Financial Aid Information
Have you applied to Georgia State for financial aid?
 Yes
 No
If you have not applied for financial aid, please do so immediately. Please this is an integral part of
the scholarship process.
What is your “estimated cost of attendance*” at Georgia State? ..............................$ ________________
What is your Total Need? $__________________
How much of the “estimated cost of attendance*” is not covered by all financial aid sources
combined (public and private; loans, grants and scholarships)? ..............................$ _______________
*Your “estimated cost of attendance is reported to you by the Office of Student Financial Aid in your
award letter and on GoSolar.
Section D: Leadership and Extra Curricular Activities
List university activities in which you are involved in and the degree of involvement; including
student organizations. State position held (i.e. President, Member) and a contact person’s name
and email address. Please list any honors, awards or recognition received.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Section E: Employment Information
Name of current employer__________________________________________________________
Dates of Employment_______________________________________________________________
Employer’s Address_______________________________________________________________________________
GEORGIA STATE UNIVERSITY FOUNDATION
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Street
City
State
Zip Code
Section F: Community Involvement
List campus or community service activities in which you are involved and the degree of
involvement. Please include a contact person’s name and email address.
Community Organization
Contact
E-mail
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Section G: Personal Statement
On a separate sheet, type a personal essay that describes your background and characterizes
your educational and career aspirations. Please tell us why you should be considered for a
scholarship. No more than 500 words.
GEORGIA STATE UNIVERSITY FOUNDATION
Generic Scholarship Application
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Revised 01/14/13
Section G: Applicant Certification
1. I understand that the amount of financial aid that I am eligible for is based on my enrollment
status, classification (undergraduate or graduate), residency, housing arrangements and aid
received from other sources. I promise to notify the Office of Student Financial Aid of any
corrections or changes to my information to prevent incorrect disbursement of my aid.
2. I authorize release of an official transcript of my academic record to the awarding unit specified
above and to the foundation for the purpose of determining eligibility for the above specified
scholarship/ award/fellowships.
3. I authorize the university to release “directory information” as defined by the University FERPA
Records Access Policy such as student name, city, state and country of residence (both local and
permanent), age and place of birth, major field of study, full or part-time status, participation in
officially recognized activities and sports, degrees and awards applied for and/or received, dates
of attendance, previous educational institutions attended and, with respect to members of
athletic teams, age, hometown, hobbies, and general items of interest to the foundation to be
shared with the donor of my scholarship.
4. I agree to allow the university and the foundation to release and use information about me and
my photographs for publications and promotional and marketing purposes.
5. I agree to participate in scholarship recipient activities, including the annual scholarship
luncheon.
6. I promise to write, under supervision of foundation representatives or staff, thank-you letter(s) to
the donor(s) my scholarship/award/fellowship.
Under penalties of perjury, I certify that the statements and information in this application are true
and accurate.
___________________________________________________
Signature of Scholarship Recipient
_________________________
Date
Submit application to:
Name:
Title:
Location:
Phone:
E-mail:
GEORGIA STATE UNIVERSITY FOUNDATION
Generic Scholarship Application
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