FSA Scholarship Application

1
Please verify that you are human* This field is required.
2
Choose your participating employer* This field is required.
Please Select
Please Select
Albertsons
Market Street
Tom Thumb
Randalls
3
I have reviewed and understand the scholarship eligibility and rules requirements.* This field is required.
YESNO
4
Are you ready to pursue a career in the retail food & beverage industry?* This field is required.
YESNO
5
Name* This field is required.
First Name
Last Name
6
Email* This field is required.
example@example.com
7
Phone Number* This field is required.
Area Code
Phone Number
8
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
Birthdate* This field is required.
Date
Month
Day
Year
10
Gender
Please Select
Please Select
Woman
Man
Prefer not to respond
11
Are you legally authorized to work in the United States?* This field is required.
YESNO
12
Which ethnicity best describes you? (Please choose all that apply.)
American Indian or Alaskan NativeAsian
Pacific Islander
Black or African American
Hispanic
White / Caucasian
Multiple ethnicity / Other
13
Have You Received an FSA Scholarship Before?* This field is required.
YESNO
14
If You Have Received an FSA Scholarship, What Year Was It?
Date
Month
Day
Year
15
Did You Receive All The Funds?
YESNO
16
What year will you or did you graduate from high school or received your GED?* This field is required.
Date
Month
Day
Year
17
School Status* This field is required.
Please Select
Please Select
I will graduate in May 2026
I will be an incoming freshman graduating high school prior to 2025
I have attended college but have less than 32 college credit hours
I have attended college but have at least 32 or more college credit hours
I am a GED graduate with no college credit hours
18
Please indicate the education program you are pursuing* This field is required.
Please Select
Please Select
Associate
Bachelor’s
Graduate
Continuing Education
Trade or Technical School
19
Name of School* This field is required.
20
School Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
21
Most recent cumulative GPA?* This field is required.
22
Intended Degree or Major* This field is required.
23
School activities, community activities, volunteer work, honors, offices held* This field is required.
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Ok
Ok
24
Will you be pursuing the WAFC Retail Certification Program?* This field is required.https://retailmanagementcertificate.com/about-us/who-is-the-wafc/
YESNO
25
What are your long-term education goals, and how does continuing your studies fit into your overall life plan at this stage?* This field is required.500 words or less
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Normal
Small
Ok
Ok
26
What are your long-term education goals, and how does continuing your studies fit into your overall life plan at this stage?500 words or less
Huge
Large
Normal
Small
Ok
Ok
27
What specific professional goals do you hope to achieve through furthering your education, and where do you see your career in three years?* This field is required.500 words or less
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Normal
Small
Ok
Ok
28
ACT or SAT Exam is not required, but helpful. If you took the ACT or SAT, in what year?
29
What was your highest score?
30
Do you have a future test date? If so, when it is?
31
Approximate number of credit hours you have completed as of January 2026?
32
Current GPA?
33
Estimated credit hours needed to complete your Undergraduate Degree?
34
Estimated cost per semester (tuition and books)
35
College / University activities, honors, offices held, etc.
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Large
Normal
Small
Ok
Ok
36
What Retailer do you work for?* This field is required.
37
Retail Store Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
38
Describe your current position; including responsibilities, average weekly hours worked and number of employees you directly supervise.* This field is required.
Huge
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Ok
Ok
39
Complete with your employment history
Store Name and Number
Position/Title
Start Date
End Date
Supervisor's Name
Supervisor's Phone
Current Job:
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Prior Job:
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Prior Job:
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Prior Job:
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Current Job:
Prior Job:
Prior Job:
Prior Job:
Store Name and Number
Row 0, Column 0
Position/Title
Row 0, Column 1
Start Date
Row 0, Column 2
End Date
Row 0, Column 3
Supervisor's Name
Row 0, Column 4
Supervisor's Phone
Row 0, Column 5
Store Name and Number
Row 1, Column 0
Position/Title
Row 1, Column 1
Start Date
Row 1, Column 2
End Date
Row 1, Column 3
Supervisor's Name
Row 1, Column 4
Supervisor's Phone
Row 1, Column 5
Store Name and Number
Row 2, Column 0
Position/Title
Row 2, Column 1
Start Date
Row 2, Column 2
End Date
Row 2, Column 3
Supervisor's Name
Row 2, Column 4
Supervisor's Phone
Row 2, Column 5
Store Name and Number
Row 3, Column 0
Position/Title
Row 3, Column 1
Start Date
Row 3, Column 2
End Date
Row 3, Column 3
Supervisor's Name
Row 3, Column 4
Supervisor's Phone
Row 3, Column 5
1 of 4
40
Name of Supervisor completing the Store Manager Comment Sheet (SMCS) * This field is required.
First Name
Last Name
41
Email address of Supervisor completing the Store Manager Comment Sheet(SMCS)* This field is required.
example@example.com
42
Marital Status
Please Select
Please Select
Never Married
Married
Widowed
Divorce
Separated
43
Your Spouse's Occupation and Employer?
44
Number of Dependents
45
Do You Support Yourself?
YESNO
46
Do You Live with Your Parents?
YESNO
47
Father's Occupation & Estimated Annual Income
48
Mother's Occupation & Estimated Annual Income
49
Do You Rent or Own a Home?
YESNO
50
Number of People in Your Household?
51
Estimated Annual Gross Household Income (including your income)?* This field is required.
52
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.* This field is required.
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Ok
Ok
53
Are you currently receiving any other financial assistance toward your education? If so, please identify the source and value.* This field is required.
54
Do You Intend to Continue to Work While Attending College?
YESNO
55
Upload Essay
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Max. file size: 10.6MB
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56
Reference Letter 1
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57
Reference Letter 2
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Max. file size: 10.6MB
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58
Store Manager's Comments Sheet (SMCS)
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Max. file size: 10.6MB
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59
High School Diploma or GED is required if you have already graduated from high school
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Max. file size: 10.6MB
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60
If currently attending high school upload unofficial transcripts
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Max. file size: 10.6MB
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61
If attending or have attended College upload unofficial transcripts
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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62
Signature* This field is required.By signing you confirm you have read and agreed to the rules and qualifications of the FSA Scholarship.
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