Name* First Last TODAY’S DATEToday's Date MM slash DD slash YYYY Target Start Semester*—Summer '23Fall '23Spring '24Summer '24Fall '24Spring '25Summer '25MAILING ADDRESSAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CONTACT INFORMATIONEmail* Phone*HIGH SCHOOL EDUCATIONHigh School Attended* Graduation Year* COLLEGE EXPERIENCECollege(s) Previously Attended* Degree Earned Number of Credit Hours GPA ESSAY Provide a personal statement essay (as part of the application) explaining the following: Why you would be a good candidate for this scholarship How do you meet at least two of the following criteria: A first-generation college student A member of an underrepresented or marginalized group (including but not limited to underrepresented racial populations, women, LGBTQI, low-income, individuals with disabilities, etc.) Have overcome personal, social, and/or physical obstacles pursuing an education and/or be from a living environment or academic setting that may have hindered educational pursuits Have demonstrated a commitment to diversity and inclusion and/or leadership in working with underrepresented groups through employment, community service, or other involvement. ESSAY SUBMISSION (Up to 500 words)*PROGRAM REQUIREMENTS Be an approved candidate as determined by an interview with the Athens State Diversity Committee or their designees Must work with one of the university-approved diversity clubs or organizations for two consecutive semesters Have a completed and accepted (current) FAFSA at Athens State University that demonstrates financial need through Pell Grant eligibility (not Pell receiving) in accordance with the FAFSA Have a minimum cumulative GPA of 2.5 Have no previous bachelor’s or master’s degree Be in a degree-seeking program Not receiving funding from Men of Kennis, Bonner Leaders, or ASSIST I agree to complete the following Program Requirements* Type your initials to show you agree with the program requirementsHow did you hear about this opportunity?* Δ