PERSONAL INFORMATION
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Are you a US Citizen?
*
Yes
No
Ethnicity (statistical data only with no bearing on the outcome):
*
Please Select
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Legal Marital Status
*
Married
Single
Are you a single mother (with adult or minor children)?
*
Yes
No
ACADEMIC INFORMATION
What college/university will you be enrolled in the fall?
*
Student ID Number
*
Address of the college/university you will be enrolled?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Admission Status for Fall 2025
*
Please Select
Full-time (12+ credit hrs.)
Part-time (less than 12 credit hrs.)
Academic Standing as of Fall 2025
*
Please Select
Freshman (0-30 hrs. completed)
Sophomore (31-60 hrs. completed)
Junior (61-90 hrs. completed)
Senior (91+ hrs. completed)
Major
*
Projected Graduation Date
*
-
Month
-
Day
Year
Date
Degree Type Pursuing
*
Please Select
Associate
Bachelor's
Master's
Doctoral
Degree Type Previously Obtained
*
Please Select
N/A
Associate
Bachelor's
Master's
Doctoral
FINANCIAL INFORMATION
Are you currently employed?
*
Yes
No
Employment Type
*
Part-Time
Full-Time
Unemployed
Annual Salary
*
Less than $35,000
$35,001 - $65,000
More than $65,000
Household Salary
*
$65,000 or less
$65,001 - $100,000
More than $100,000
Number of dependents in your household (per FAFSA and/or income tax return):
*
Number of dependents (including yourself) who will be enrolled in college this fall
*
Are you willing to provide your current SAR (Student Aid Report) from your FAFSA or most recent IRS tax transcript?
*
Yes, I am willing to provide my current SAR or most recent IRS tax transcript to be considered for tuition assistance.
No, I am not willing to provide my SAR or IRS tax transcript, which will forfeit my scholarship eligibility.
Will you be able to continue your studies if you do not receive a scholarship after the fall semester?
*
Yes
No
As a winner, would you be willing to donate 5% of your scholarship to help other single moms? (no obligation)
*
Yes
No
SUPPLEMENTAL INFORMATION
Upload your documentation here
Proof of enrollment (Acceptance Letter, Class Schedule, or Billing Statement - Either document must be OFFICIAL)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Transcript (MOST RECENT OFFICIAL college or high school transcript from registrar only)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Current Student Aid Report from FAFSA or most recent IRS tax transcript
*
Browse Files
Drag and drop files here
Choose a file
You may request your tax transcript at https://www.irs.gov/individuals/get-transcript
Cancel
of
Write a short essay providing background information on yourself and how a financial scholarship from Dr. CGK Foundation, Inc. will benefit your educational journey.
*
0/500
By signing below, I acknowledge that I have fully read and understood the requirements outlined and that all information submitted is, to the best of my knowledge, accurate and complete. I further understand that submitting false information will result in automatic disqualification.
*
By signing below, I acknowledge that attending the awards ceremony on the evening of July 26, 2025 in Sugar Land, TX is required.
*
Submit
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