<p> WOMEN’S FORUM STUDENT SUCCESS EMERGENCY SCHOLARSHIP APPLICATION COVER SHEET</p><p>Name Laker ID# </p><p>Major Overall GPA Major GPA </p><p>Currently pursuing ______Associate Degree ______Bachelor’s Degree</p><p>Number of semesters completed (to date) at Clayton State </p><p>Expected Graduation Date </p><p>Phone (to best reach you) </p><p>Email </p><p>Signature </p><p>Note: Your signature above grants the Clayton State Women’s Forum the authority to verify any and all information related to this application. Also, by signing the application you are stating that you have completed at least one semester at Clayton State, have no more than two full semesters remaining before graduation, and have an Overall GPA of 2.5 or higher.</p><p>1. Complete (type) all pages indicated for Women’s Forum Student Success Emergency Scholarship, including short essay</p><p>2. Obtain copy of Graduation Evaluation Summary</p><p>3. Obtain documentation of emergency</p><p>4. Assemble all parts of the application packet:  This cover sheet  Completed 2-page application form  Answer to SHORT ESSAY on separate document  Copy of Graduation Evaluation Summary  Documentation of sudden emergency</p><p>5. Submit application packet in hard copy form to Nicole Harris Office of Budget and Finance Woodlands Hall, CSU East,Ste. 124 [email protected]</p><p>APPLICATION PACKETS MAY BE SUBMITTED AT ANY TIME THROUGHOUT THE YEAR</p><p>Incomplete application packets will not be considered</p><p>Women’s Forum Emergency Scholarship Application Page 1 Attach additional pages if needed Women’s Forum Student Success Emergency Scholarship Application</p><p>Last 5 numbers of Laker ID </p><p>Employment Experience for Past Five Years (list most recent first)</p><p>Employer Position Start/End Dates Hours/Week</p><p>1. </p><p>2. </p><p>3. </p><p>4. </p><p>5. </p><p>6. </p><p>7. </p><p>Financial Aid Received for Past Three Years</p><p>Type of Award Amount Number of Years Received</p><p>1. </p><p>2. </p><p>3. </p><p>4. </p><p>5. </p><p>6. </p><p>7. </p><p>List Additional Financial Resources (contributions from family members or friends, personal fund- raising projects, sponsorships)</p><p>Women’s Forum Emergency Scholarship Application Page 2 Attach additional pages if needed Women’s Forum Student Success Emergency Scholarship Application</p><p>Last 5 numbers of Laker ID </p><p>Academic Honors List your academic accomplishments (for example, undergraduate research; publications or presentations; membership in honor societies; scholarships or awards, volunteer tutoring) Include dates. Do not abbreviate names of organizations. Significant achievements other colleges are acceptable.</p><p>Campus and Family Activities List your participation in campus projects, family activities (that are not routine), on-campus organizations, or volunteer involvement.</p><p>Community Service Briefly describe your participation in community projects or organizations.</p><p>SHORT ESSAY On a separate piece of paper, write one or two paragraphs describing the emergency that will keep you from continuing your education, other factors related to your need, and how you expect to use the funds. The essay should be no more than 200 words.</p><p>Women’s Forum Emergency Scholarship Application Page 3 Attach additional pages if needed</p>