Erin K. Dowell RENEWAL Scholarship Application

Applicant
Name:*

First NameMiddle NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Email:*
example@example.com
Birthdate:*

MonthDayYear
What is your IL county of residence?*

HendersonHancockMcDonoughMercerWarrenOther

Your Plans
Please list the name of the school you are currently attending:*
Please list the name of the school you plan to attend in the fall:*
What is your major/course of study:*
Amount saved (by parents and self) for Higher Education:*
List the scholarships, tuition waivers, and/or other financial assistance you have currently applied for, include the values of all. Also include whether you received, did not receive, or are still waiting to find out for each:*
Estimated tuition cost for the year:*
Estimated Room and Board cost for the year:*
Estimated other cost(s) for the year (please break down):*
Yearly cost of education not covered by scholarships or grants:*

Work History

Work history is required for this scholarship. Please list all work history information below.
Employer:*
Supervisor's Name:*
Supervisor's Phone Number:*
Supervisor's Email:*
example@example.com
Start Date of Employment:*
End Date of Employment:*
Hours Worked per Week:*
Hourly Pay Rate:*
Employer #2:
Supervisor's #2's Name:
Supervisor #2's Phone Number:
Supervisor #2's Email:
example@example.com
Start Date of Employment:
End Date of Employment:
Hours Worked per Week:
Hourly Pay Rate:
Please share any other work experience(s) not listed above:

References
Name of a Reference we can contact:*
Reference Phone Number:*
Reference Email:*
example@example.com
The following priorities will be used to determine eligibility:
- Students who may not have other scholarship opportunities due to scholastic performance but possess the motivation to attempt and complete needed additional education training.
- Students who are unlikely to have the opportunity for further education or training without this award.
- Students who have unique or specialized educational needs not served by traditional scholarships.
- Students who have limited or lacking family support infrastructure to successfully compete for traditional scholarships.
- Students who work at a paying job to help support themselves and/or their family.
- Non-traditional students who have a desire to further their education.
- Students from Henderson County will receive priority.
Please explain why you should receive this award. Please address the parameters of eligibility (listed directly above this question) in your response and include your future goals: *

Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all listed information is accurate.

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:*
Date:*
Should be Empty:

Erin K. Dowell Endowed Scholarship Renewal Form