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APPLICATION FORM
Directions: Please read the pages of program requirements and instructions. To apply for a fellowship,
the student must complete the application form below along with submitting a personal letter of need for
the fellowship. The application should be sent to Mrs. Leslie Jones, Masters Reality-based Enhanced &
Applied Learning (REAL) Grant Coordinator, BILLY C. BLACK Building #192, or scan a copy (with
hand written signatures) to the Coordinator’s email at Leslie.Jones@asurams.edu .
Personal letter from applicant: Masters Reality-based Enhanced & Applied Learning (REAL) Grant
Program funds are awarded to facilitate scholastic excellence, relieve financial need, and promote
community service and student support for the grant. Please describe how the fellowship will enable you
to be successful in completion of your education in the expected time frame.
DEADLINE: The fellowship application deadline is December 14, 2017
Name (full name):_____________________________________________________________________________
Date of birth: ____________________ _______ SSN#__________________________________________
Citizenship: U.S. Citizen Yes/No_______ U.S. Permanent Resident ______Yes/No_____________
Student ID number ___________________________________________________________________________
Home phone number: ___________________________ Cell phone: ______________________________
Home address: _______________________________________________________________________________
Work phone number: ____________________________ Work Hours_____________________________
ASU E-mail: _________________________________________________________________________________
Cumulative GPA: _____________________________________________________________________________
Current Academic Status - Full-time/Part-time:_______________ Race: ______________________________
Single Income: __________________ Married/Family Income: _________________________
Number of people in household: ____________ Work Schedule - Full-time/Part-time:_____________
Impact of funds on ability to increase course load:
If money awarded, would you adjust work schedule to allow graduation within the designated time frame?
JYJ/lj/10/2017
Albany State University Masters Reality-based
Enhanced & Applied Learning (REAL) Grant
Student Expectations
Must be Enrolled in the Albany State University Graduate Program
o Math Education, Nursing, or Science Education
Will be a full-time student at Albany State University.
Maintain a GPA of 3.0.
Regularly attend tutorial sessions as needed online and on ASU campus.
Attend and participate in all required ASUREAL program meetings.
Must demonstrate professional behavior while interacting with other students, staff,
faculty, and administrators.
Attend scientific meetings and present their research at the request of their professors
(including the Graduate Research Symposium.
Must have a curriculum vitae and “Statement of Goals” in the Grant Coordinator’s
office (updated each Fall).
***All applicants should carefully review these expectations. If unable to meet the above
stated expectations, the applicant should not enter or remain in the Albany State University
Masters Degree Reality-based Enhanced & Applied Learning (REAL) Grant.
** Your signature below states that you agree to the terms, expectations and conditions of this fellowship. **
***I, ____________________ attest that all the financial information in the above
application is true to the best of my knowledge and any false reporting of information will
lead to the fellowship being terminated.