LSLA Scholarship/Concentration Application Form 1. CSUN ID # * 2. Last Name * 3. First Name * 4. Email Address * 5. Address 6. City 7. Zip Code 8. Phone Number * 9. Have you filed a Free Application for Federal Student Aid (FAFSA)? Yes No 10. Will you be able to commit to 45 hours of fieldwork during the academic year * Yes No 11. How did you hear about the scholarship? Please include a brief essay (100 words or less) explaining why you would like to participate in the program. 12. Essay * Authorization Release: I authorize the Liberal Studies Program to obtain my financial aid information. I also give permission for my photographs, video, and statement to be used for the purposed of promotional material and publications and waive any rights to compensation or ownership. 13. Release * Agree Disagree Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.
