Roger Heintz Youth Scholarship Fund

Roger Heintz Youth Scholarship Fund

Application Form
This application must be completed and recieved by the ARCHA by NOVEMBER 3 annually in order to be considered for the current scholarship year.

Please ensure application is complete with all attachments.
Name

First NameLast Name
Email
example@example.com
Phone Number
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Academic Information
Current Grade or Year Level
Latest GPA Score
Date Expected to Graduate

MonthDayYear
Date
Education Information
Name of School
Program and Major
Degree / Certification Aspiring to
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Required Attachments
Copy of transcripts from most recent High School or Post Secondary Institution

Cancelof
Essay describing your involvement with the ARCHA

Cancelof
And additional information you would like to submit

Cancelof
I agree that all information provided is true and correct to the best of my knolwedge, and any misrepresentation may eliminate me from scholarship consideration. If selected, I agree that my name will be released publicly on ARCHA website & social media.
Applicant's Signature

Clear
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Guardian's Signature

Clear
Name of Guardian

First NameLast Name
Date Signed by Guardian

MonthDayYear
Date
Should be Empty: