Special Scholarship Consideration Request

Special Scholarship Consideration Request

Use this form to request additional scholarship consideration by providing your student information, reasons for appeal, and a statement of circumstances.
Full Name

First NameLast Name
Student ID Number
SEU Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Degree
Major
Current Class
Expected Graduation Date

MonthDayYear
Date
Reason for Request
Please select the primary reason for your request (choose all that apply):

Other educational circumstance (please explain)
Statement of Circumstances
Please describe your situation, why you are requesting additional scholarship assistance, when the circumstances occurred, how they have affected your ability to continue your education, and the steps you have taken to address the situation.
Is there anything else you would like the Scholarship Review Committee to know?
Student Certification
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submission of this form does not guarantee additional funding. Additional documentation may be requested. Scholarship awards are subject to funding availability and donor restrictions. Providing false or misleading information may result in denial of my request or other institutional action.
I agree to the certification above.
Student Signature (electronic)
Date

MonthDayYear
Date
Should be Empty:

Reason for Request