School of Nursing

Scholarship Form

This information is optional for admission, but required for enrollment. The information is requested for statistical record keeping only and will not be considered in any admissions decision. Clayton State is required to report sex and race/ethnic information to certain federal and state agencies as those data relate to civil rights compliance. The School of Nursing will review this information to determine eligibility for scholarship opportunities.

Last Name
First Name
Middle Name
Laker ID (900XXXXXX)

 

Semester and year of program entry  
Current semester of program enrollment

 

Age
Gender
Marital status
Ethnicity
Primary language spoken at home
Place of birth (e.g. Atlanta, Georgia)
High school name and location
Religious affiliation
Planned area of specialization

 

First generation college student (neither parent holds a college degree)
Learning support requirements at college/university level
Highest education level completed to date

 

Citizenship/residency status (NOTE: ineligible for some funds if in this country on student or visitor visa)
Citizen, national, or lawful permanent resident of

 

Student's current household income $ (adjusted gross income as reported on most recent income tax form)
Number of dependents (as listed on federal income tax form)

 

Parent's household income $ (when all dependents were in household)
Number of dependents (as listed on federal income tax form)

 

 

BY CLICKING THE SUBMIT BUTTON BELOW