2SLGBTQIA+ Leadership Graduate Student Award form

Home Address
(School or Department)
Are you enrolled at ASU this Spring 2023 semester?
One file only.
100 MB limit.
Allowed types: pdf, doc, docx.
One file only.
100 MB limit.
Allowed types: pdf, doc, docx.

I confirm with my signature that the information I have provided to the College of Liberal Arts and Sciences 2SLGBTQIA+ Leadership Graduate Student Award Committee is accurate and true to the best of my knowledge. I understand that the award is granted at the discretion of the Scholarship Committee, and I give the committee permission to access all academic or other necessary information needed to determine my eligibility. I understand that accepting this award may affect my financial aid package.

I authorize, with my signature below, that if selected as a Leadership Graduate Student Award recipient, my name and likeness may be used for publicity, promotion and advertisement by Arizona State University (ASU).


The Federal Family Educational Rights and Privacy Act (FERPA) protects the privacy of educational records that the university maintains about me. By signing below, I give permission for Arizona State University to disclose to the scholarship donors and any review committee the information provided in connection with this scholarship application for the purpose of the review of my application, and the administration and promotion of the scholarship program. This may include information from my educational records such as my official transcript, letters of recommendation, and financial aid information. This permission is granted for each semester I am awarded a scholarship from the CLAS Leadership Graduate Student Award Program. If I am selected as a recipient, my name and image may be used for publicity, advertisement, and promotion by the College of Liberal Arts and Sciences. All applications remain confidential and become the property of the CLAS Leadership Graduate Student Award Program.

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ONLY ELECTRONIC SUBMISSIONS WILL BE ACCEPTED All questions and submissions should be directed to thecollege-grad@asu.edu before the deadline of March 10, 2023 by 5:00pm.