CPS Citizenship Program

Individual Application

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone #:

E-mail :

Reason for application: Describe current situation and use of award

Other grants/gifts currently awarded

If scholarship application, list current school and contact information, plus accomplishments

General information you would like us to consider when reviewing your application

Amount of request:

How did you hear about us?

Search Engine

CPS Representative

Other (please specify below)

I authorize CPS Citizenship staff to verify information I have provided on this application.

Thank you for applying to the CPS Citizenshp Program. All applications are reviewed between the 20th and 30th of each quarterly month end. You will be notified that your application has been A) selected B) carried over to the next quarter or C) declined.