Application for the
Service - Disabled
Veterans Scholarship
-UndergraduatesInstructions: To apply for the Service-Disabled Veterans Scholarship, please be sure to submit this application and additional
requirements by October 30 for Spring semester consideration or by June 30 for Fall semester consideration. All credentials should
be submitted to the SPGIA Undergraduate Academic Affairs office located in Robinson Hall, Room A201, Fairfax Campus.
Last or Family Name
Personal
Information
First
MI
Permanent Address:
State
(H)
G Number
Present Mailing Address: valid until____________
Street
City
Other
(W)
Apt. No.
Street
Zip Code
City
(H)
Area Code and Telephone No.
Apt. No.
State
Zip Code
(W)
Area Code and Telephone No.
E-mail Address
Program
Information
SPGIA Undergraduate Program: ___________________________________
Cumulative GPA: __________
Intended Semester/Year of Graduation: ________________________
Are you receiving GI Bill Funding?
YES
NO (Please circle)
If selected, I understand that I will be required to complete a one semester paid internship with Enterprise Resource
Performance, Inc. _____________ (please initial)
Program
Information
Additional
Requirements
Honor
Code/Release
Statement
We request that you submit the following items with this application:
1.
2.
3.
A one-page statement addressing your interest in public service.
Provide a copy of Form DD214, Proof of Service Record
Provide Service Connected Disability (SCD) rating
Please note: If SCD rating is not available, please provide VA Form 21-526, The Veterans Application for
Disability Compensation.
George Mason University shares the tradition of an honor system that has existed in Virginia since 1842. The Honor Code is an
integral part of university life, and it is the student’s responsibility to understand the provisions of the code. Attempted cheating,
plagiarism, lying, and stealing constitute Honor Code violations. In the spirit of the code, students and faculty members must report
all violations to the Honor Committee. The Honor Code can be found in the University Catalog.
I certify all information given on the application is true and correct, and I will read and accept the responsibility of the Honor
Code if I am approved for admission to George Mason University.
I understand that information about me known to the Admissions and/or the Office of Financial Aid may be used to evaluate
my eligibility for a scholarship, and I authorize those offices to release information to the appropriate scholarship committees.
I further authorize release of my application to third parties for the purpose of scholarship consideration. If selected for a
scholarship, I authorize release of information to be given to donors or used in publicity related to the scholarship program. I
further agree that I will notify the Office of Student Financial Aid of any changes (major, residence, etc.), which may affect my
eligibility for a restricted award.
Signature _________________________________________________________ Date _________________________