Undergraduate Application

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I, certify that I have read and understand the instructions for applying for the Belle Zeller Scholarship.

Name*

COLLEGE INFORMATION

CUNY ID

College

Major

Cumulative GPA

Number of Credits

Expected Date of Degree

PERSONAL INFORMATION

Email address*

Secondary Email

Phone Number*

Street Address

State

City

Zip

EMPLOYMENT INFORMATION

Employer

Work phone

Work Address

Employer 2

Work Phone (Employer 2)

Work Address (Employer 2)

Employer 3

Work Phone (Employer 3)

Work Address (Employer 3)

COMMUNITY SERVICE

Organization Name

Address

Dates

Supervisor

Duties

Organization Name 2

Address 2

Dates 2

Supervisor 2

Duties 2

Organization Name 3

Address 3

Dates 3

Supervisor 3

Duties 3

EXTRACURRICULAR ACTIVITIES

Organization Name

Address

Dates

Description of Activity

Organization Name 2

Address 2

Dates 2

Description of Activity 2

Organization Name 3

Address 3

Dates 3

Description of Activity 3

OTHER ACTIVITIES

Activity Name

Dates

Description of Activity

AWARDS

Award Name

Awarded by

Description

Year awarded

UPLOADED DOCUMENTS

Transcript

Statement

Bursar Receipt

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