African American Faculty & Staff Association Scholarship and Award Application

Outstanding Senior Award

Instructions: Return this application to the African American Resource Center- H222B, 800 N. State College Blvd. Fullerton, CA 92834 by May 1^st 2006. Please complete all sections of this form and attach an essay of 250 words or less that describes the impact you have made both on the CSUF campus and in your local community. Discuss your leadership attributes and your future goals upon graduation. Your essay should provide compelling evidence as to why you should be chosen as this year’s Outstanding Graduate. This form must be typed or printed legibly in black ink. If printing is not legible, your application will be disqualified.

Personal Background

________________________ _____________________ _____

Last Name First Name M.I.

___________________________ _____________________ ______ ______

Street Address City State Zip

_____________________ _____________________ __________________

Work Phone Home Phone CSUF I.D. Number

Financial Information

Did you receive financial aid during your undergraduate studies at CSUF? (circle one)

Yes No

Educational Objective for Graduate Studies

_____________________ ______________________ ____________

University Major Anticipated Grad Date

Certification

I certify that, to the best of my knowledge and ability, the above information is true, correct and complete. University staff has the right to verify all information provided. Providing misinformation may result in mandatory repayment of the scholarship and/or award.

_____________________ ________________

Signature Date

Return this form along with your essay and two letters of recommendation to the African American Resource Center- H222B by Monday, May 1, 2006.