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About Us
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Funding Opportunities
Faculty
Community Organizations
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ignesco
2022-09-21T20:48:25-05:00
Outreach Scholars Application
** Applicants must be a Mississippi resident and a US citizen to be eligible to apply. **
Are you a Mississippi Resident?
*
Yes
No
Are you a Louisiana Resident?
*
Yes
No
Are you a US Citizen?
*
Yes
No
Applicant Information
Personal Statement - Maximum of 2 pages allowed
*
Accepted file types: jpg, gif, png, pdf, doc, docx, pages, xlsx, xls, Max. file size: 10 MB.
State your future goals and how you think this program will help you reach those goals.
Resume
*
Accepted file types: jpg, gif, png, pdf, doc, docx, pages, xlsx, xls, Max. file size: 10 MB.
Name
*
First
Last
Preferred Name
*
Date of Birth
*
MM slash DD slash YYYY
Cell Phone #
*
Permanent Phone #
*
Permanent Non-Academic Email Address
*
Academic Email Address
*
Permanent Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Current Mailing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Academic Institution
*
Declared Academic Major
*
Anticipated Graduation Date
*
MM slash DD slash YYYY
GPA (4.0 scale)
*
Please enter a number from
0
to
10
.
Academic Classification
*
Incoming Freshman
Freshman
Sophomore
Junior
Senior
Graduating Senior (you haven't started any graduate school work/programs)
Graduate Student
Gender
*
Male
Female
Non-binary
Prefer not to say
Ethnicity - I identify my ethnicity as: (select all that apply)
*
Asian
Black/African American
Caucasian
Hispanic/Latinx
Native American
Pacific Islander
Prefer not to answer
Other
Are you a first generation college student?
*
Yes
No
I don't know
I prefer not to answer
How did you hear about our program?
*
Social Media
Website
Referral from friend or teacher
Presentation from recruiter
From flyer or email distributed at my school
Do you understand and agree?
*
I understand and agree
By submitting this application, you agree that all information provided is truthful representation of myself as a student application for consideration of award.
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