GRAD Last Mile Fund Application

Full Name

ID Number

UMass Boston Email Address

Major

Please list your expected graduation date and ensure this matches your WISER record

How many credits do you need to complete your degree program?

Please list the names of the remaining classes and requirements that are needed to complete your degree program as they are listed in your degree audit.

Have you completed your Writing Proficiency Exam? If no please list your plan to complete this degree requirement.

Who is your academic advisor?

What do you intend to do after graduation? If you plan to enter the work force, what type of work will you be doing? Please describe:

Who referred you to the GRAD Last Mile Fund?

Amount of assistance needed $:

How do you intend to use the GRAD Last Mile Fund scholarship?

How will the GRAD Last Mile Fund help you complete your degree? Please include any helpful details.

Are you a parent?

YesNo

Place of Birth?

What high school did you attend?

Disclaimer and Signature

By accepting the GRAD Last Mile Fund scholarship, I agree to register for classes for the upcoming semester and work towards completing degree.*

By submitting this form, I consent to the use of information provided in this form and my student records for research purposes, to inform strategies to strengthen the GRAD Last Mile Fund program and improve student outcomes. I understand that my information may be made available to GRAD Last Mile Fund partners including but not limited to the City of Boston and affiliated researchers.*

Sharing your information is voluntary. You can still take part in GRAD Last Mile Fund even if you do not consent to the use of your information for program improvement and research purposes. For questions or concerns or if you do not want your information to be used for research or evaluation purposes please contact Daniel MacLeod at Daniel.macleod@umb.edu

Protecting your privacy is very important. Only authorized persons will have access to your information, except as required by law. Your personal records will be kept strictly confidential by all parties to whom access is granted. Your name will never be used publicly, nor will any description that could identify you. Information in this form will be shared for aggregate program reporting purposes, but we will not use the students’ information to link back to college/academic records, NSC files, or BPS records.

I have read and agree to the above conditions.*