GEAUX TEACH SCHOLARSHIP APPLICATION
INSTRUCTIONS: Complete this application if you are interested in applying for a Geaux Teach Scholarship. If you need assistance completing this application, call 800-259-5626 or e-mail geauxteach@la.gov.
Section I. Applicant Information
1. First Name:
*
First Name
Middle Initial
Last Name
2. Permanent Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3. Mobile Phone Number:
*
Format: (000) 000-0000.
Alternate Phone Number:
Format: (000) 000-0000.
4. Applicant's Date of Birth:
*
-
Month
-
Day
Year
Date
5. Applicant's LOSFA ID:
If you do not know or have your LOSFA ID number,leave this blank
6. Louisiana Driver's License Number or State-Issued ID Number:
*
7. Email address:
*
example@example.com
8. Are you a U.S. citizen?
*
Yes
No
9. How long have you been a Louisiana Resident?
*
10. If required, are you registered with Selective Service?
*
Yes
No
Not Applicable
11. Are you enrolled in a full-time program?
*
Yes
No
12. Which degree are you seeking?
*
Undergraduate
Teacher Certification
13. What is your field of study?
*
14. Have you previously received a Geaux Teach Scholarship?
*
Yes
No
15. If you answered yes to Question 14, how many semesters have you received this scholarship?
Section II. Certification
Please check only one box that applies to you.
*
I certify that I am an undergraduate student majoring in education and have at least a 2.50 cumulative grade point average.
I certify that I have a bachelor's degree and that I am enrolled full-time in a certified alternative teacher preparation program.
Section III. School or Alternative Provider
Please select your school or alternative provider from the dropdown menu.
*
Please Select
A+PEL Educators
Centenary College of Louisiana
Grambling State University
iteachLOUISIANA
La Christian University
Louisiana Resource Center for Educators (LRCE)
Louisiana State University-Alexandria
Louisiana State University-Baton Rouge
Louisiana State University-Shreveport
Louisiana Tech University
Loyola University New Orleans
McNeese State University
Nicholls State University
Northwestern State University
Southeastern Louisiana University
Southern University-Baton Rouge
Southern University-New Orleans
Teach St. Bernard (TeachSB)
The New Teacher Project (TNTP Academy)
Tulane University
University of Holy Cross
University of Louisiana at Lafayette
University of Louisiana Monroe
University of New Orleans
Xavier University of Louisiana
Section IV. Signature
BY SIGNING BELOW OR BY SUBMITTING THIS FORM TO LOSFA I CERTIFY UNDER PENALTY OF PER-JURY THAT THE INFORMATION I HAVE PROVIDED TO LOSFA IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Applicant Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Printed Name of Applicant:
*
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