GDAC Legacy Fund Request Form

The Greater Dayton Alumni Chapter (GDAC) Legacy Fund provides financial assistance to students at Central State University who have incurred outstanding balances. This one-time grant can award up to $1,000 to help students maintain their enrollment and continue their education. The fund aims to support students in overcoming financial barriers and achieving their academic goals. All requests will be reviewed, and students will be notified of the decision

Applicant Information:

First name

Last name

Email

Phone

Birthday

Add Your Home Address

Country/Region

Address

City

Zip / Postal code

School Address (On Campus Address)

Academic Information:

Academic Program:

Student ID#

Current Year (e.g., Freshman, Sophomore):

Last Term Attended

Cumulative GPA:

Expected Graduation Date:

Financial Information:

Total Balance Owed to Central State University:

Have you applied for Financial Aid?

Yes

No

Reason for Request:

upload a current bill dated within the last 30 days:

Certification:

I hereby certify that the information provided above is true and accurate to the best of my knowledge. I understand that this is a one-time request and that the amount awarded will be applied directly to my balance at Central State University. I also acknowledge that larger balances will be considered based on the fund's capacity and the impact on my ability to remain in school.

Signature

GDAC Legacy Fund Request Form

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