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.
