IAC College Scholarship Application Form

NROTC Scholarship Application Form
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Information
Name of High School Attended
Year of graduation
Ranking in Graduation Class
Current GPA
Graduate Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Class Rank
Extra-Curricular/Community Service
SAT
Date Taken
V/CR
Math
Writing
ACT
Date Taken
Composite Score
COLLEGE GOALS
Degree Pursing
List of Colleges/Universities applied/accepted to:

Family Information
Number of Siblings
Are you the first person in your family to go to college?
Number of Siblings in College
Financial Information
Are you a dependent of your Parents?
Your Family's Joint Annual Income
ANNUAL HOUSEHOLD INCOME

I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE APPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Applicant's Signature
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: