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Center for Student Diversity

Community Enrichment and Enhancement Partnership (CEEP) Award Application

PLEASE NOTE: The personal information requested will be used to determine your eligibility for the CEEP Award. All fields marked with an asterisk are optional. Excluded information may affect the ability of the Center for Student Diversity (CSD) to determine your eligibility for the CEEP award, and/or to contact or notify you of your eligibility. You have the right to inspect, amend and/or correct all information on this form by contacting the CSD in person or in writing. The information on this form is not available for public inspection, and will not be shared with anyone outside CSD, with the exception of the University’s Office of Financial Aid.

For questions, please e-mail rwoodus@towson.edu.

A. STUDENT STATUS

Please mark your status



B. PERSONAL INFORMATION

1.

2. / /

3.
 
4. Male Female

5. Married Single Divorced

6.

7.

8.

9.

10.
With parents/relatives On campus Off campus

11.
African American
Asian American
Caucasian
Hispanic American
Native American
Other

12.
United States Citizen
Permanent Resident
Student Visa
Other

13. Yes No

Mother
Father

14. Yes No

C. STUDENT DATA

1.

2. FOR INCOMING FRESHMEN ONLY

3. FOR INCOMING TRANSFERS ONLY


  
4. FOR CONTINUING STUDENTS ONLY

Classification:

Enrollment Status:

Year in School:

Are you a degree seeking student?

D. EMPLOYMENT

1. Are you currently employed?

2. Do you plan to work during the academic term you are seeking the CEEP Award?

3. Where do you plan to work?

E. FINANCIAL AID

1.

F. COMMUNITY INVOLVEMENT

1.

2.

G. PLANNED CEEP INVOLVEMENT

1.

2.

H. ADDITIONAL INFORMATION

1. Are there factors in your social and/or academic backgrounds that could have interfered with your educational goals?

2. Did you overcome personal, social and/or physical obstacles in order to pursue your education?


3.

I. CERTIFICATION

I certify that the information I have submitted on this application is accurate, true, and complete.

 


 

 

 

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