2022 Warren Scholarship Application

PERSONAL QUESTIONS

Please answer the questions below.
1. Please describe the environment that you come from – for example, your family, community, or school – and how this environment has influenced what you value most about your heritage. (250 word limit) *

0/250
2. Describe how you have demonstrated your commitment to diversity, inclusion, equity, or social justice through your school involvement, work experience, community service or other activities and how you plan to continue your commitment during college. (250 word limit)*

0/250
3. How will this scholarship make a difference to you? (100 word limit)*

0/100
4. Please list any colleges and or universities to which you are applying or plan to apply (Please keep in mind that you must attend an Ohio College or University to be considered for this scholarship). *

High School Activities and Awards:

Please list activities which include, but are not limited to, participation in schools organizations/clubs, community service/volunteering, after school or summer programs, etc.
Activities in high school*
Activities outside of high school*
Please share additional information/other evidence of special talents, honors, or awards that you have received.
Please list family responsibilities or other circumstances that have affected your involvement in school organizations or related activities.

Additional Information:
Is there anything else that you would like to share with us about yourself? If not, please type no.*

HIGH SCHOOL COUNSELOR RECOMMENDATION

Please provide us the name, email address, and phone number for your high school counselor recommendation. A form will be emailed to your counselor to complete on your behalf.

Be sure to enter the correct email address and phone number below. If you list an incorrect email address, your counselor will not be automatically contacted to submit the recommendation form.
High School Counselor Name*

First NameLast Name
High School Counselor Email*
Phone Number*

Area CodePhone Number
OPTIONAL Additional Recommendation

You may submit one additional letter of recommendation from a teacher, employer, clergy or someone who has worked with you through a community organization. A request to submit the letter of recommendation will be emailed to your recommender. Please list their contact information below.
Additional Recommender Name

First NameLast Name
Additional Recommender Position/Title
Additional Recommender Email
example@example.com
Additional Recommender Phone Number

Area CodePhone Number

CERTIFICATION

Please read statement and sign below

I affirm that the information that I have provided on this application form and any additional material that I submit is complete, accurate and true to the best of my knowledge. I authorize each high school that I have attended to release academic and personal information, as related to this scholarship application.

I acknowledge that I must attend an Ohio college or university to receive this scholarship.

Please use the box below to sign your name.
Signature*
Date*

MonthDayYear
All form submissions will be sent to the Inclusion, Access, and Success Committee
Should be Empty:

Scholarship Information