Form CG-6054 "Coast Guard Foundation Scholarship Application"

What Is Form CG-6054?

This is a legal form that was released by the United States Coast Guard on December 1, 2005 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2005;
  • The latest available edition released by the United States Coast Guard;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CG-6054 by clicking the link below or browse more documents and templates provided by the United States Coast Guard.

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DOC. NO
U.S. DEPARTMENT OF
Coast Guard Foundation
HOMELAND SECURITY
U.S. COAST GUARD
Scholarship Application
CG-1112
CG-6054 (12-05)
APPLICANT DATA:
.
Ms
Mr.
Last Name:
First Name:
MI:
Street Address:
City:
State:
Zip Code:
/
/
/ / /
DOB: Month
Day
Year
Student Tel #:
Sponsor Tel #:
Student E-mail:
High School Data: Will you graduate from high school this year? Yes
No
/
/ / /
Expected high school graduation date: Month
Year
Cumulative GPA:
(convert on a 4.0 basis)
Rank in Class:
of
High School:
City:
State:
College Data:
Did you attend college last year? Yes
No
If yes, give your GPA
(convert on a 4.0 basis)
List the undergraduate US college/school you attend or the colleges/schools where you have applied.
Name:
State:
Name:
State:
Major:
/
/ / /
Expected college graduation date:
Month
Year
Expected college degree: AA
BA
BS
Other
If other, please explain:
Community Service and Extra-Curricular Activities Data:
Please provide information that relates to activities occurring during the last 4 years of high school to the present. You may
attach a resume highlighting your service or activities.
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-6054 (Rev. 12-05)
Reset
.
DOC. NO
U.S. DEPARTMENT OF
Coast Guard Foundation
HOMELAND SECURITY
U.S. COAST GUARD
Scholarship Application
CG-1112
CG-6054 (12-05)
APPLICANT DATA:
.
Ms
Mr.
Last Name:
First Name:
MI:
Street Address:
City:
State:
Zip Code:
/
/
/ / /
DOB: Month
Day
Year
Student Tel #:
Sponsor Tel #:
Student E-mail:
High School Data: Will you graduate from high school this year? Yes
No
/
/ / /
Expected high school graduation date: Month
Year
Cumulative GPA:
(convert on a 4.0 basis)
Rank in Class:
of
High School:
City:
State:
College Data:
Did you attend college last year? Yes
No
If yes, give your GPA
(convert on a 4.0 basis)
List the undergraduate US college/school you attend or the colleges/schools where you have applied.
Name:
State:
Name:
State:
Major:
/
/ / /
Expected college graduation date:
Month
Year
Expected college degree: AA
BA
BS
Other
If other, please explain:
Community Service and Extra-Curricular Activities Data:
Please provide information that relates to activities occurring during the last 4 years of high school to the present. You may
attach a resume highlighting your service or activities.
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-6054 (Rev. 12-05)
Reset
Page 2 of CG-6054 (12-05)
EMPLID NO. Verification
Coast Guard Foundation
Scholarship Application
CG-1112 only
Coast Guard Sponsor Data:
Pay Grade:
Rank:
Employee ID (Do not give your social security number)
Last Name:
First Name:
MI:
Coast Guard Unit:
City:
State:
District:
Area:
Sector:
ISC:
Yes No
Active Duty (If yes, date entered on active duty)
Reserve on extended active duty (If yes, give start date of present duty assignment)
Retired (If yes, date of retirement from the Coast Guard)
Deceased (If yes, provide date)
Print Name (Father):
Tel #
Print Name (Mother):
Tel #
Student/ Sponsor Certification:
We certify that, to the best of our knowledge, all responses are true and factual, the sponsor, as well as the applicant, has
reviewed the eligibility requirements. We verify the applicant is unmarried and has not reached the age of twenty-three (23)
on this day. We also agree, if the applicant is selected as a scholarship recipient, applicant, parent and sponsor name,
along with sponsor duty location will be used for purposes of news and publicity of the Coast Guard Foundation
Scholarship Program by Commandant (CG-1112) and the Coast Guard Foundation for current and future promotions of the
scholarship program.
Signature of Applicant:
Date:
Print Name:
Signature of Sponsor:
Date:
Print Name:
5 U.S.C. 552(a) Privacy Act
a. AUTHORITY: 5 U.S.C. § 301 Departmental Regulations
b. PURPOSE: To collect information for the purpose of processing requests for consideration for award of a Coast Guard Foundation
Scholarship.
c. ROUTINE USES: Used in the performance of official duties related to the processing of scholarship documents. Viewed by the selection
panel and Coast Guard Foundation staff.
d.
DISCLOSURE: Voluntary; however failing to provide the information may result in disqualification from consideration for award of a Coast
Guard Foundation scholarship.
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-6054 (Rev. 12-05)
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