The Williams Center for Undergraduate Student Achievement

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APPLICATION FORM

Last

First

Middle Initial

Student Number

Age

Date of Birth

Home or Mailing Address

City

State

Zip

Student E-Mail Address

Student Home Telephone

Student Cell Telephone

High School (If you are a freshman):

High School/College GPA

Major

Do you plan to get a 4 year degree?

If so, which College do you plan on attending?

Are you interested in attending one of the following?

Awards/Extracurricular Activities:

STUDENT ESSAY: Applicants must submit a typewritten essay using Times New Roman (12pt) font with a minimum of 450 words. In the essay, tell us about yourself and why you are the right candidate for the Williams Center For Undergraduate Student Achievement.

Essay must accompany application. **INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED . (Upload Essay Below)

If selected as a WCUSA as a candidate, I understand in order to receive the scholarship and/or stipend, I must maintain an overall GPA of 2.0.

APPLICATION SUBMISSION and ACKNOWLEDGEMENT FORM

CHECKLIST REMINDERS:

Review the following:

ACKNOWLEDGEMENT

By signing below, I agree to the following:

If selected as member of the WCUSA, I will be committed to do the following:

• If selected as a WCUSA candidate, I will participate in the Selection Interview @ SUSLA with WCUSA selection committee.
• If selected as WCUSA candidate, I agree to have my Selection Interview recorded.
• If selected as a WCUSA candidate, I will attend weekly Accountability meetings with the WCUSA director and/or representative.
• If selected as a WCUSA candidate, I will participate in Professional Development sessions as scheduled.
• If selected as a WCUSA candidate, I will attend Peer Group monthly as scheduled.
• If selected as a WCUSA candidate, l will attend Academic Learning Communities as scheduled.
• If selected as a WCUSA candidate, I will participate in scheduled Community Services events.
• If selected as a WCUSA candidate, I will represent WCUSA and SUSLA in a positive and professional manner at times on campus and in the community.

Please click here to open the Acknowledgement form, download, and/or save form to your computer.

Download Adobe Acrobat Reader here to sign the Application electronically.  Once you have completed the Adobe Acrobat download, open the Acknowledgement form in Adobe Acrobat Reader and sign by selecting  on the top bar.  Save document and attach below.  

 

Note:

To access the Electronic Signature option, you must have Adobe Pro on your computer. If you are not able to sign your application electronically, applications with ALL required documents may be faxed to: WCUSA Director Ted Scott or email to tscott@susla.edu.

Upload Signed Acknowledgement Form

Upload Essay Here

Upload Other Required Documentation