Application Form

Webform February 28, 2023

First and Last Name: *

Pronouns: *

Student ID: *

Stan State Email: *

Phone: *

Class Standing in Fall of 2024: *

First Year

Second Year

Third Year

Fourth Year

Fifth Year+

Expected Graduation Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20222023202420252026

GPA: *

Major: *

Minor (if applicable):

Dietary Restrictions:

Accessibility Accommodations:

Eligibility and Statement of Understanding: *

I am currently a full-time Stanislaus State undergraduate student.

I understand the contact information provided through this form will be used to notify me of my application status.

I understand that only completed applications will be reviewed. A completed application includes the submission of all required documents by the deadline.

I understand that my GPA must be above a 2.5 (cumulative) to qualify for the fellowship.

I understand you must be a senior-level student (with 90 or more units) to qualify for the fellowship.

I understand the stipend relating to the purchase of a laptop or a computer must be used for this intended purpose.

Resume: *

Application Essay: *

Letters of Recommendation: *

Transcripts: *