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General Scholarship Application Form:

Please complete this form to apply for a scholarship with GETCAPSS.ORG.

Personal Information:

First name*

Last name*

Birthday*

Month

Day

Year

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Academic Information

Current School/Institution Name*

Current Grade Level or Year*

GPA or Academic Standing

Intended Major or Field of Study*

Expected Graduation Date*

Scholarship Criteria

Are you a first-generation college student?*

Yes

Are you involved in any extracurricular activities or volunteer work? *

Yes

Are you involved in any extracurricular activities or volunteer work?

Extracurricular Activity / Role / Duration *

Extracurricular Activity / Role / Duration

Volunteer Work / Role / Duration *

Volunteer Work / Role / Duration

Personal Purpose Statement

Essay/Persona: Please provide a brief response below or attach a separate document if required. In 500 words or fewer, explain why you are applying for this scholarship and how it will impact your future goals.

Personal Purpose Statement

Financial Information

Household Income Range

Under $30,000

$30,000 - $60,000

$60,000 - $90,000

$90,000 - $120,000

Above $120,000

Number of Dependents in Household

Do you currently receive any other scholarships or financial aid?

Yes

If yes, please specify the scholarship name and amount.

References

Please list at least two academic or professional references

Reference #1 Name and Last name*

Relationship to Applicant*

Phone*

Email*

Reference #2 Name and Last name*

Relationship to Applicant*

Phone*

Email*

Additional Information

Are there any special circumstances that you would like us to consider? Provide a brief answer.

Any Additional Notes or Special Requests. Specify any preferences or questions.

By signing below, you confirm that all information provided is accurate and complete to the best of your knowledge.

Signature of Applicant (Type your complete name here)*

Date picker*

GetCAPSS.org.

CLARANCE DIAS EDMEADE

Email: diascedmeade@getcapss.org

Phone +1-954-658-1070

Address: 738 NE 125th Street, Miami, 33161

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