Queen Scholarship Application

PERSONAL INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Are you a US Citizen?*

YesNo
Ethnicity (statistical data only with no bearing on the outcome):*
Legal Marital Status*

MarriedSingle
Are you a single mother (with adult or minor children)?*

YesNo
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

CityState / Province

Postal / Zip Code
Admission Status for Fall 2025*
Academic Standing as of Fall 2025*
Major*
Projected Graduation Date*

MonthDayYear
Date
Degree Type Pursuing*
Degree Type Previously Obtained*
FINANCIAL INFORMATION
Are you currently employed?*

YesNo
Employment Type*

Part-TimeFull-TimeUnemployed
Annual Salary*

Less than $35,000$35,001 - $65,000More than $65,000
Household Salary*

$65,000 or less$65,001 - $100,000More 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?*

YesNo
As a winner, would you be willing to donate 5% of your scholarship to help other single moms? (no obligation)*

YesNo
SUPPLEMENTAL INFORMATION

Upload your documentation here
Proof of enrollment (Acceptance Letter, Class Schedule, or Billing Statement - Either document must be OFFICIAL)*

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Transcript (MOST RECENT OFFICIAL college or high school transcript from registrar only)*

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Current Student Aid Report from FAFSA or most recent IRS tax transcript*

You may request your tax transcript at https://www.irs.gov/individuals/get-transcript
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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. *
Should be Empty:

PERSONAL INFORMATION

ACADEMIC INFORMATION

FINANCIAL INFORMATION

SUPPLEMENTAL INFORMATION