Undergraduate Web Application - Belle Zeller Scholarship Trust Fund

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

Yes I Agree

Empl ID Number*

First Name*

Middle Initial

Last Name*

Mailing Address*

City*

State*

Zip*

Cell Phone*

Secondary Phone

Email*

Non-CUNY Email*

Employer

Employer’s Email

Employer’s Phone

CUNY Colleges*

CUNY Cumulative GPA*

Major*

Number of CUNY Credits*

Expected Graduation Date (Semester and Year)*

Did you attend college other than your current college*

Name of Other College(s) including CUNY you attended within the last 5 years

Credits Earned

Volunteer Community Service Site Name*

Dates Worked*

2nd Volunteer Community Service Site Name

2nd Dates Worked

Extracurricular Activities

Dates

Awards

Dates

CUNY Unofficial Transcript (s) Uploaded *

Other Unofficial Transcript (s) Uploaded

Other Official Transcript Uploaded

Statement describing your community service work in detail (submit as a pdf file only)*

Email address of letter of recommendation writer*

Email address*