FSA Scholarship Application

FSA SCHOLARSHIP FOUNDATION Scholarship Program | Application

Application Deadline - Friday, April 26, 2024
Your email address is very important as our link to you. You will receive an email from FSA as proof of receipt of your application, for your interview date, and final results. Make sure you're checking your email frequently. Thank you.
I. Personal Data
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Email*
Phone Number*

Area CodePhone Number
Birthdate*

MonthDayYear
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Optional Information

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation and is important to FSA and its 501 (c) (3) status. It does not affect your selection for a FSA scholarship award.
Gender

MaleFemale
Are you a US citizen?

YesNo
Race (Choose one or more)

WhiteBlack or African AmericanAsianAmerican Indian or Alaskan Native Hawaiian or Other Pacific IslanderNon-Resident Alien
III. Education Information
What year will you or did you graduate from high school or received your GED*
Status at the time of application*

I will graduate in May 2024I will be an incoming freshman graduating high school prior to 2024I have attended college but have less than 32 college credit hoursI have attended college but have at least 32 or more college credit hoursI am a GED graduate with no college credit hours
Most recent high school cumulative GPA*
Name of high school*
High school City/State*
Name of College or University currently attending or plan to attend*
Degree or Major planned*
Will you be pursuing WAFC Retail Certification Program?*
High School activities, community activities, volunteer work, honors, offices held*
IV. Plans and Goals
Describe your education goals and explain why you have decided to further your education at this time.*

0/300
How do you plan to pay for college?*
Describe your PROFESSIONAL GOALS and tell us where you see yourself in 5 years.*
V. ACT or SAT Information
ACT or SAT Exam is not required, but helpful. If you took the ACT or SAT, in what year?
Overall score?
Do you have a future test date? If so, when it is?
VI. For Students Currently Enrolled at a College or University
Approximate number of credit hours you have completed as of January 2024
Current GPA
Estimated credit hours needed to complete your Undergraduate Degree
Estimated cost per semester (tuititon and books)
College or University activities, honors, offices held, etc.
VII. Employment
What Retailer do you work?*
Retailer Store Number*
Describe your current position; including responsibilities, average weekly hours worked and number of employees you directly supervise.*

Complete with your employment history*

	Store Name and number	Position/Title or Duties	Start Date	End Date	Supervisor's Name	Phone Number
Your Current Job at:
Next Prior Position as:
Next Prior Position as:
Next Prior Position as:

VIII. Personal Household Information
Select One
Number of Children
STEP 1: Do you live with your parents? (If No, go to STEP 2)*
Continue: Father's occupation and estimated annual income
Continue: Mother's occupation and estimated annual income
STEP 2: Do you own a home or rent, for how long?*
Continue: Do you support yourself?
Continue: Number of people in your household?
Continue: Number of dependents you support including yourself?
Your Spouse's occupation and employer?
STEP 3 Estimated annual gross household income including your income?*
Do you have unusual expenses? Do you have any unusual medical expenses? Do you have any unusual circumstances that we should be aware of? Explain any unusual circumstances below.*
Are you currently receiving any other financial assistance toward your education? If so, please identify the source and value.*
IX. Extras
FSA Scholarship Foundation offers scholarships to individual with a sincere interest in the food retailing industry. We offer aid to students that represent this interest. Please check each of the qualifiers below that apply to you. This data helps us understand you. Please note, if you are awarded a scholarship based on any of these qualifiers, you will be asked to produce documentation verifying your unique eligibility.
I read and understand the FSA Scholarship Foundation Rules and Qualifications for the FSA Scholarship.*

Yes
Have you received an FSA Scholarship before?*

YesNo
If you have received an FSA Scholarship, what year did you receive the scholarship and did you collect all funds?
Do you reside in one of the FSA participating counties?*

YesNo
Are you interested and willing to major in fields related to the Retail Grocery Industry?*

YesNo
Do you intend to continue to work at your grocery store while attending college?*

YesNo
If so, will you work

Full-timePart-time
X. Essay
Essay*

Browse Files

Cancelof
XI. Upload Documents
First Personal Reference Letter*

Browse Files

Cancelof
Second Personal Reference Letter*

Browse Files

Cancelof
Store Manager's Comments Sheet (SMCS)

Browse Files

Cancelof
High School Diploma or GED is required if you have already graduated from high school

Browse Files

Cancelof
ACT or SAT Scores are not necessary, but are helpful

Browse Files

Cancelof
If attending high school now, high school transcripts are required

Browse Files

Cancelof
If attending or have attended College transcripts are required

Browse Files

Cancelof
X. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature*
Signature

Clear
The FSA Scholarship Foundation is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

FSA SCHOLARSHIP FOUNDATION Scholarship Program | Application

I. Personal Data

III. Education Information

IV. Plans and Goals

V. ACT or SAT Information

VI. For Students Currently Enrolled at a College or University

VII. Employment

VIII. Personal Household Information

IX. Extras

X. Essay

XI. Upload Documents

X. Applicant's E-Signature