Form Hud-30007 - Community Development Work Study Program Student Data Sheet - U.s. Department Of Housing And Urban Development
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1Community Development Work
U.S. Department of Housing
OMB Approval No. 2528-0175
(exp. 9/30/2010)
and Urban Development
Study Program
Office of University Partnerships
Student Data Sheet
The information collection requirements contained in this notice of funding availability and application kit will be used to rate applications,
determine eligibility, and establish grant amounts for the Community Development Work Study Program, (CDWSP). Total reporting burden for
collection of this information is estimated to average 1hour. This includes time for reviewing instructions, searching existing data resources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. The information submitted in response
to the notice of funding availability for CDWSP is subject to the disclosure requirements of the Department of Housing and Urban Development
Reform Act of 189 (Pub. L. 101-235, approved December 15, 1989, U.S.C. 3545). The agency may not conduct or sponsor, and a person is not
required to, a collection of information unless the collection displays a valid control number.
Institution:_____________________________________
Grant #: CDWS____-____-_____
Date of Report :_____________
Interim:_____________
Final: _____________
Student::______________________________
Gender:_________
Ethnicity: (Select one)
Hispanic or Latino
Not Hispanic or Latino
Race: (Select one or more)
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Other Pacific Islander
White
Date Student Entered Program: _____________
Degree/Major/Concentration: __________________________________
Hours Required for Degree: ____________ Qtr. Hrs. or ____________ Semester Hrs.
Hours Completed Through Reporting Period: ____________
Cumulative GPA:____________
Work Placements: Initial
Second
Third
(Check appropriate placement)
Agency Name:___________________________________________________________
Position:________________________________________________________________
Start Date: _____________
End Date: _____________
Date Student Will Graduate/Did Graduate From Program: _____________
Date Student Withdrew* From Program Without Completion: _____________
Grant Funds Expended Through This Reporting Period:
Administrative Allowance
____________
Work Stipend
____________
Tuition and Fees
____________
Additional Supprt
____________
* An explanation of students’s withdrawal must accompany the Student Data Sheet
form HUD-30007 (10/2002)
Previous versions obsolete
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