Cream City Foundation LGBTQ+ Scholarship Form 2017


CONTACT INFORMATION

* - Required Fields.







(only if different)

YesNo
State of Residence: *

County of Residence (Wisconsin residents only):
 

Permanent address



State: *

School address (if different)

If yes please provide address?





PERSONAL INFORMATION

High School CounselorCollege Financial Aid OfficerWord of MouthEvent/WorkshopNewspaper/PublicationCream City Foundation WebsiteOther Online SiteFacebook/TwitterOther



We support every individual's right to self-identify in regards to their sexual orientation and gender identity. In order for us to better understand the people we are serving, we ask that you select the options that most closely apply to you.


LesbianGayBisexualHeterosexual/StraightQueerQuestioningTwo SpiritSame Gender LovingAsexualPansexualPrefer not to discloseOther Sexual Orientation



FemaleMaleMTF (Male to Female) TransgenderFTM (Female to Male) TransgenderTransgender/TransexualGenderqueergender non-conformingIntersexPrefer to not discloseOther Gender Identity


Your Gender pronoun(s)


American Indian or Alaska NativeAsianBlack or African AmericanHispanicNative Hawaiian or Other Pacific IslanderWhiteTwo or More RacesOther


ACADEMIC INFORMATION

High School/Home School/GED*

(If you have attended more than one school, only use details of the latest institution below.)




 

Current Institution*







PERSONAL BIOGRAPHY

Please write a brief personal biography highlighting your work, goals, and merits. This statement will serve as an introduction to our Board of Directors and as a website bio for those who choose that option. Please write this statement in the third person as in the example below. (Maximum 100 words.)

(Example: Taylor Williams is attending the University of Wisconsin and pursuing an undergraduate degree in Political Science. An advocate for the rights of communities of color and LGBTQ communities, they hope to instigate change through action, inspiring youth to recognize their own potential to learn and transform the world. Taylor has made becoming an immigration lawyer their long-term goal, working with communities that are frequently denied access to resources due to their identities and social spheres.)


(100 Words Maximum)

ESSAY

Please complete the following required essay. (Maximum 750 words).

Use the following questions as prompts to tell us about yourself and your commitment to public service within the LGBTQ+ community.

  • What are your plans or goals for having a positive impact on the LGBTQ+ community?
  • What are your career plans, and how does your area of study contribute to these plans?
  • What community organizations or groups have you been involved with, and what was your role with these organizations?
  • If you haven't had the opportunity to be involved with any community organizations, please let us know what your future plans are for being engaged in the community.
  • Describe a character defining moment for you, which might include a challenge or barrier that you have faced as an LGBTQ+ individual or ally.
  • What did you learn from this experience, what kind of cultural awareness did you develop, and how did that influence your personal values and goals?


(750 Words Maximum)

WAIVER AND PERSONAL INFORMATION RELEASES

If you receive this scholarship, we may wish to publicly release information about this. Please let us know which of these things you give us permission to do.

Additionally, regardless of whether or not you receive this scholarship, corporate donors to this scholarship fund may be interested in contacting you regarding possible internship opportunities at their companies. Please let us know if you are comfortable with us releasing your contact information to them. We will not release your contact information to individuals who have made donations to this scholarship.

I grant permission to Cream City Foundation to publish an announcement of my scholarship award on its website. *

YesNo

I grant permission to Cream City Foundation to issue a press release that announces my scholarship award. *

YesNo

I grant permission to Cream City Foundation to use my photograph in its publicity releases about my scholarship award. *

YesNo

I grant permission to Cream City Foundation to use my biography statement in its publicity releases about my scholarship award. *

YesNo

I grant permission to Cream City Foundation to use my photograph on its website. *

YesNo

I grant permission to Cream City Foundation to use my biography statement on its website. *

YesNo

I grant permission to Cream City Foundation to release my email address to companies who have donated to this scholarship fund. *

YesNo

I grant permission to Cream City Foundation to release my phone numbers to companies who have donated to this scholarship fund. *

YesNo

I grant permission to Cream City Foundation to release my address to companies who have donated to this scholarship fund. *

YesNo