LGBTQIA+ Scholarship Application 2024 Scholarship Form Step 1 of 3 33% Contact InformationName(Required) First Last What are your gender pronouns?(Required)Let us know which pronouns you would like to go by so folks know how to address you.They/ThemShe/HerHe/HimOtherYour pronouns(Required)Phone Number(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What part of the LGBTQ+ community do you identify with?If you receive this scholarship, would you require confidentiality?(Required) Yes No School InformationPlease provide information about your community college, high school, continuation school, or nontraditional G.E.D school.School Name(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code SubmissionsLetters of RecommendationWhat is the name of the first person who wrote your letter of recommendation?(Required) First Last What is your relation to them?(Required)Are they your teacher, counselor, employer, mentor?What is their email?(Required) First Recommendation(Required)Max. file size: 512 MB.What is the name of the second person who wrote your letter of recommendation?(Required) First Last What is your relation to them?(Required)Are they your teacher, counselor, employer, mentor?What is their phone number?(Required)What is their email?(Required) Second Recommendation(Required)Max. file size: 512 MB.AutobiographyWrite an autobiography describing your Queer experience in Southwest Wisconsin. This prompt is very open-ended, and you may write about anything that relates to your experience as an individual that identifies with the LGBTQ+ community or how your allyship became a focus for you. You may choose to include any obstacles or barriers that you may have faced or struggled with your gender identity and/or sexual identity. Most importantly, we would like you to view this as an opportunity to share your story because we all have one and it deserves to be heard. We are not looking for a perfect grammatical structure, nor are we looking for an extravagant resume. We simply want you to share your story through the perspective of an LGBTQ+ individual or ally (650-word maximum).Tell us your story.(Required)Goals and AspirationsPlease describe your goals and aspirations and how you wish to achieve them. (250-word maximum).Tell us your goals, dreams, and hopes.(Required)ConsentI hereby confirm and certify that all of the information above is accurate and truthful to the best of my knowledge and has been written and submitted by me. I certify that I meet all eligibility requirements as specified on this application. I release this information to the Central Valley Scholars and its staff for the purposes of evaluating my scholarship application. I understand that the information given may be investigated and that any false representation and/or evidence of plagiarism is sufficient to cause for rejection of this application or forfeiture of all awarded funds. I agree to the privacy policy.Signature(Required)EmailThis field is for validation purposes and should be left unchanged.
