Scholarship Application Form Page 2
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3NYSTAA 2017 Scholarship Application (Please type)
Name _____________________________________________________________
Address _____________________________________________________________
____________________________________________________________________
Phone _____________________________________________________________
Email _____________________________________________________________
Name of Two-year College: ________________________________________
Cumulative GPA: _______________________ # Credits to Date: ________________
Degree: ○ AA ○ AS ○ AAS
Date of Graduation: __________________
Other College(s) attended: _______________________________________________
_______________________________________________
List College(s) Applying to: _______________________________________________
_____________________________________________________________________
Intended Major: _______________________________________________
Recommendation
List the name of the person who will be providing a letter of recommendation.
Please ask him/her to mail or email the letter directly.
Name: _______________________________________________________________
Title/Relationship to you: ________________________________________________
Recommender’s email address: ___________________________________________
Essay
On a separate sheet of paper, please write an essay indicating your educational plans
and how they will fit into your career goals. Explain how this scholarship will help you
in meeting these goals. Include anything else you might want to add that may not be
included elsewhere on the application.
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