For Transgender Identified Students in the Helping and Caring Professions

Next deadline for applications is January 10, 2009

Application - Part 1

Please send the following information:

Applicant Info

• Your Name
• Current Address:
  • Street Address
  • City
  • State
  • Zip Code
  • Current Phone:
    • Area Code
    • Phone Number
• Permanent Home Address:
  • Street Address
  • City
  • State
  • Zip Code
  • Permanent Phone:
    • Area Code
    • Phone Number
• Social Security Number:
• Birth Date:
  
  (Applicants of all ages are encouraged to apply)

Because some award funders designate specific criteria for individual grants, please provide the following information. You may choose to not provide this information. This information is voluntary and will not negatively affect your consideration for non-specific awards.

• Your Ethnic, Racial or Cultural Identification:
• Your Religion or Spiritual Affiliation:
• Your Gender:

Educational History

• High School you attended or GED program you completed (include city, state)
• Post-secondary/other education programs completed (most recent first) and dates attended

Post-Secondary Plans

• Institution you are attending or plan to attend in the next academic year (name, city, state):
• Type of School:
  • Trade School/Technical School
  • College (undergraduate)
  • College (grad school)
  • Other (Please specify_______________)
• Admission Status:
  • Planning to apply
  • Applied
  • Accepted
  • Already attending
• Intended course of study (or actual course, if already attending):
• Current class status (1st year, 2nd year, junior, senior):
• Hours completed so far:
  • ____ Quarter hours or ____ Semester hours

Confidentiality

All documents received by the TSELF awards committee are considered confidential. However, some material is carefully selected from applications and letters of reference to prepare introductions of the recipients at the annual awards presentation ceremony.

• If chosen to receive an award, TSELF may make your name and other information available to members of the press who report on the awards. This will be at the sole discretion of TSELF. Applicants who chose not to sign below will not be eligible for TSELF awards. Please indicate that you have read and agree to this by signing and dating below:
• Signature______________________
• Date signed ___/___/___

Additionally, award recipients may be asked to allow the use of their photograph for the benefit of our members and fund donors. The use of such photographs will only be done with the express permission of the recipient, and refusal to comply will in no way prejudice that individual's award status or affect possible future applications.