Form HUD-3007 Community Development Work Study Program Student Data Sh

Community Development Work
Study Program
Student Data Sheet

U.S. Department of Housing
and Urban Development
Office of University Partnerships

OMB Approval No. 2528-0175
(exp. 03/31/2007)

The information collection requirements contained in this notice of funding availability and application kit will be used to rate applications,
determine eligibility, and establish grant amounts for the Community Development Work Study Program, (CDWSP). Total reporting burden for
collection of this information is estimated to average 1hour. This includes time for reviewing instructions, searching existing data resources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. The information submitted in response
to the notice of funding availability for CDWSP is subject to the disclosure requirements of the Department of Housing and Urban Development
Reform Act of 189 (Pub. L. 101-235, approved December 15, 1989, U.S.C. 3545). The agency may not conduct or sponsor, and a person is not
required to, a collection of information unless the collection displays a valid control number.

Institution:_____________________________________
Date of Report :_____________

Interim:_____________

Student::______________________________
Ethnicity: (Select one)

Grant #: CDWS____-____-_____

Gender:_________

Hispanic or Latino

Race: (Select one or more)
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Final: _____________

Not Hispanic or Latino

Asian
White

Black or African-American

Date Student Entered Program: _____________
Degree/Major/Concentration: __________________________________
Hours Required for Degree: ____________ Qtr. Hrs. or ____________ Semester Hrs.
Hours Completed Through Reporting Period: ____________
Work Placements:

Cumulative GPA:____________

Initial
Second
Third
(Check appropriate placement)

Agency Name:___________________________________________________________
Position:________________________________________________________________
Start Date: _____________

End Date: _____________

Date Student Will Graduate/Did Graduate From Program: _____________
Date Student Withdrew* From Program Without Completion: _____________
Grant Funds Expended Through This Reporting Period:
Administrative Allowance
Work Stipend
Tuition and Fees
Additional Supprt

____________
____________
____________
____________

* An explanation of students’s withdrawal must accompany the Student Data Sheet

Previous versions obsolete

form HUD-30007 (10/2002)