Transgender College Scholarship Application - Eastern PA Transgender Equity Project

Personal Information

Current Legal Name*

First Middle Last

Chosen Name*

First Middle Last

Pronouns*

Permanent Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

What is Your Age?*

What is Your Ethnicity?*

Asian
Black / African American
Caucasian / White
Hispanic / LatinX
Native American
Pacific Islander
Mixed
Other

Education Information

High School Attended*

Graduation Date*

G.P.A and class Ranking (%)*

If you have a GED, when did you receive it?

School/College You Last Attended (include dates and number of credit hours completed)*

School/College You Will be Attending*

Intended Major or Course of Study*

Please describe any academic awards or other honors you have received.*

Extra-Curricular Activities

Please describe any extra-curricular activities you have participated in. Please include the number of years involved for each activity.*

Please describe any community service activities or organizations you are involved with.*

In 2-3 short paragraphs, explain why are you applying for this Scholarship and how your experience as a transgender individual will inform your educational experience.*

Financial Information

Average household monthly expense after tax (the household includes yourself and any others who are supporting you financially)*

Average household monthly income after tax (the household includes yourself and any others who are supporting you financially)*

Please describe your financial situation including your needs.*

References

Please provide two references. One must be a school counselor, teacher or administrator. Include full names, titles, and contact information.*

Other Information

How did you learn about this Scholarship?*

Have you ever applied for a grant from Eastern PA Trans Equity Project in the past?*

Yes
No

If yes, what type of grant did you apply for?

Please share any other information that will help the Committee to make a decision with regard to granting financial assistance.

Would you like to receive the Eastern PA Trans Equity Project / LV Renaissance Newsletter?

Yes
No

Affirmation

I affirm that the information in this application is true and accurate according to my knowledge.*

I affirm that the information in this application is true and accurate according to my knowledge.