First Name (as it appears on your ID)

Last Name (as it appears on your ID)

Lived First Name

Pronouns

UC Berkeley Email

Non Berkeley Email

Phone

SID

Birthday

What languages do you speak in addition to English?

If you selected Other or would like to provide more details about your gender identity, please do so in the field below.

What is your residential status?

Hometown

Please indicate whether you live in the Residence Hall, a co-op or are a member of a Fraternity or Sorority.

What will be your Fall address (if known)?

Are you a transfer student?

Expected Graduation Year

What is your major?

Are you a first-generation college student, meaning your parents, guardians, or grandparents did not attend college?

The Haas Leaders scholarship is for students who cannot afford to serve 10-15 hours a week because they need to work to pay for school. Upon reviewing the program details, please describe how this scholarship will support your leadership goals and what you hope to gain by being a Haas Public Service Leader. The information you share will only be accessed by the reviewing committee. (Please limit your response to 250 words.)

What is your current SAI (Student Aid Index) listed on your CalCentral account or FAFSA/CADAA? Note: Filing FAFSA is required to verify financial need.

1. Why are you applying for a position as a Public Service Center Student Director? Share two relevant skills and give examples of how you applied these skills in the past. (Please limit your response to 400 words.)

2. Describe your leadership style. (Please limit your response to 200 words.)

How did you hear about this program?

Would you like to receive a monthly email of service and leadership opportunities, scholarships, and more?

Yes

Cisgender Female	Cisgender Male
Transgender Female	Transgender Male
Gender Non-Conforming/Nonbinary	Genderqueer
Agender	Other
Decline to State

Alternative Breaks	Bridging Berkeley
BUILD	Cal in the Capital
College Corps	Community Projects Leader
CREATE	Public Service Internship Program
Residential Service Initiative	Volunteer Income Tax Assistance (VITA)