Language
English (US)
Español
CWIMA Scholarship Application
Applicant Name
*
First Name
Last Name
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent | Guardian Name(if under 18 years of age)
First Name
Last Name
Parent | Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
High School You Attended
*
Year Graduated or Will Graduate
*
Are you employed?
*
Yes
No
Employer's Name
Employer's Phone Number
Supervisor's Name
Proposed School
*
Please Select
NTC
Mid-State
Nicolet
Other
Other Proposed School Name:
Proposed Major | Area of Study:
Starting Date
*
-
Month
-
Day
Year
Date
Expected graduation Date:
*
-
Month
-
Day
Year
Date
I affirm that the information provided on this application and supporting material is complete, accurate, and true to the best of my knowledge. I understand that providing false information may cause me to lose consideration or having financial aid revoked.
Applicant Signature
*
Date
-
Month
-
Day
Year
Date
Parent | Guardian Signature (if applicant is under 18 years of age)
Date
-
Month
-
Day
Year
Date
CWIMA may request your photograph or testimonial for public relations purposes if we select you as a scholarship recipient.
Do You Agree?
*
YES, I approve of the use my image and personal information.
NO, I do not approve of the use of my image and personal information.
Applicant Signature and Date
*
Parent | Guardian Signature and Date
Did you attend a Heavy Metal Tour in 8th Grade?
*
Yes
No
If you answered yes and did attend a Heavy Metal Tour, did it influence the shop classes you took in high school and/or help you decide on a career path?
Please explain why you chose your proposed area of study:
*
Is there anything else you would like to tell us about yourself?
Thank you!
Please verify that you are human
*
Submit
Should be Empty: