Send us your information below, and we will email you our full scholarship application. We look forward to receiving your form! Thank you so much for your interest in our scholarship program. Application Request Form Application Request Form Name * First Name Last Name Email * High School Grade Do you live in Los Angeles? * Yes No Are you a first-generation college applicant? * Yes No If you answered "yes" to the above, does your household income fall under 1.5x the federal poverty line? Yes No Not Sure Not Applicable Is your country of citizenship one of the below? Please select as appropriate. South Sudan Burundi Central African Republic Democratic Republic of the Congo Mozambique Niger Malawi Liberia Madagascar Yemen Somalia Sierra Leone Chad Solomon Islands Mali Burkina Faso Togo Vanuatu Zimbabwe The Gambia Haiti Lesotho Guinea-Bissau Uganda Guinea Rwanda Sudan Comoros Papua New Guinea Kiribati Tanzania Timor-Leste Ethiopia São Tomé and Príncipe Zambia Benin Senegal Micronesia Republic of Congo Cameroon Nepal Myanmar Tajikistan Tuvalu Marshall Islands Nigeria Samoa Kyrgyz Republic Côte d'Ivoire Pakistan Not Applicable Why do you want to pursue higher education? * How did you hear about this opportunity? * Feel free to tell us anything here. Thank you!
