The Education Group

Private School
Fellowship Program™

Requirements

Application

Private School
Information

University
Information

Private School fellowship ProgramTM
Student Application

Required Student Information:

First Name:    Middle Initial:

Last Name:

Birth Date:

Social Security Number:

African-American      Hispanic-American      Asian-American
Other:

Are you a U.S. citizen?
     Yes      No

College Contact Information:

Address:

City:

State:    Postal Code:

Phone:

Email:

Permanent Home Contact Information:

Address:

City:

State:    Postal Code:

Phone:

Email:

College Information:

College Currently Attending:

Class Level (at time of application):
     Junior      Senior      Graduate

Major Field of Study:

Minor:

Are you in a Teacher Education Program?
     Yes      No

If "yes" and you are selected for this program, will you need to receive Student Teacher Credit?
     Yes      No

Grade Point Average in Major:

Overall Grade Point Average:

Leadership/Activities Information:

Leadership positions held and activities you have been involved in during college:

Leadership positions held and activities you were involved in during high school:

Work History Information:

Have you worked during college?
     Yes      No

If yes, list the places of employment during college
(include dates and positions held):

Did you work during high school?
     Yes      No

If yes, list the places of employment during high school
(include dates and positions held):