First Name *

Last Name *

GVSU Charter School *
- Select Option Achieve Charter Academy Arbor Academy Augusta Academy Black River Public Elementary School Black River Public Middle/High School Byron Center Charter School Canton Preparatory High School Chandler Woods Charter Academy Cornerstone Jefferson-Douglass Academy Covenant House Academy Detroit - Central Covenant House Academy Detroit - East Covenant House Academy Detroit - Southwest Covenant House Academy Grand Rapids Covenant School - Spectrum Crossroads Charter Academy - Elementary Crossroads Charter Academy - Middle/High Detroit Achievement Academy Detroit Enterprise Academy Detroit Merit Charter Academy Detroit Premier Academy Detroit Prep Eagle's Nest Academy East Arbor Charter Academy Endeavor Charter Academy Evergreen Academy Excel Charter Academy Flint Cultural Center Academy Fostering Leadership Academy Gerald Dawkins Academy Global Heights Academy Grand River Academy Grand River Preparatory High School GEE Compass Academy Hanley International Academy Hillsdale Preparatory School Kalamazoo Covenant Academy Knapp Charter Academy Legacy Charter Academy Light of the World Academy Lincoln-King Adams-Young Academy 6-8 Lincoln-King Adams-Young Academy High School Madison-Carver Academy Martin Luther King Jr. Education Center Academy Metro Charter Academy Michigan Mathematics and Science Academy Muskegon Covenant Academy New Paradigm College Prep New Paradigm Glazer Academy Oakland Academy Old Mission Peninsula School Reach Charter Academy Paragon Charter Academy PrepNet Virtual Academy New Paradigm Loving Academy Saginaw Covenant Academy South Canton Scholars Charter Academy Taylor Preparatory High School The Greenspire School Timberland Charter Academy UPAD - Elementary UPAD - Middle/High UPA - Ellen Thompson Elementary UPA - Mark Murray Elementary UPA - Middle UPA - High UPSM - Elementary UPSM - Middle UPSM - High Vanderbilt Charter Academy Vanguard Charter Academy Walker Charter Academy Warrendale Charter Academy Washington-Parks Academy Westfield Charter Academy West Michigan Academy of Arts and Academics West Michigan Aviation Academy Westfield Preparatory Academy William C. Abney Academy Windemere Park Charter Academy

Employment Start Date (Full-Time) *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Position (e.g. Teacher, Assistant Principal) *

EMPLOYER ISSUED Email Address *

Phone Number *

PIC - To locate your PIC, log in to MOECS. Using the Navigation Menu "Manage Demographics" on the left side of the screen, move to the "Personal Information" screen. If you have a PIC, it will be listed. *

G-number *

In the following section, we ask which course(s) you wish to receive scholarship funds for.

PLEASE list the course(s) by their catalog prefix and code (e.g. EDF 671, EDS 614)

Fall 2024 Semester Course(s) *

The course(s) I am requesting the scholarship for will be: *
- Select Option Singular learning experience(s), not degree seeking Taken as part of a degree program

Program *
- Select Option Educational Specialist in Leadership Educational Technology - Graduate Certificate in Online/Blended Instruction Educational Technology - Online M.Ed. in Educational Technology Educational Technology - Traditional/Hybrid Educational Technology EMU/GVSU Doctoral Program in Educational Leadership Higher Education - Emphasis in Adult and Higher Education Higher Education - Emphasis in College Student Affairs Leadership Instruction and Curriculum - Emphasis in Early Childhood Education Instruction and Curriculum - Emphasis in Educational Differentiation Instruction and Curriculum - Emphasis in Elementary Education Instruction and Curriculum - Emphasis in Secondary Level Education Leadership - Emphasis in Educational Leadership Leadership - Emphasis in Special Education Administration Literacy Studies - Emphasis in Reading/Language Arts Literacy Studies - Emphasis in Teaching English to Speakers of Other Languages Professional Master of Arts in Social Innovation School Counseling Special Education Emphasis in ASD Special Education - Emphasis in Cognitive Impairment Special Education - Emphasis in Emotional Impairment Special Education - Emphasis in Learning Disabilities Teaching Certificate Renewal Graduate Endorsement - Any Undergraduate Endorsement - Any Other Program Not Listed

Program *

How would the course(s) enrich your expertise in your current role? *

How would the course(s) enrich your expertise in your current role? *

Describe how the knowledge gained through the course(s) will help you address a specific need in your classroom or school. *

Describe how the knowledge gained through the course(s) will help you address a specific need in your classroom or school. *

I understand that if I drop or fail any course(s) for which I am awarded scholarship funds, I will receive a balance on my Student Account, which I will be responsible for paying. *
Yes, I understand.

I understand that if I do not maintain employment at my current school during the semester for which I receive scholarship funds, I may receive a balance on my Student Account, which I will be responsible for paying. *
Yes, I understand.

I hereby confirm that I have thoroughly reviewed the provided information and completed this application truthfully and accurately.