Scholars Support Application Spring 2024

Name*

First NameLast Name

Personal Email*

Phone Number*

College of DuPage Student Email*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Date of Birth:*

How did you hear about this Assistance League Scholarship? Please select all that apply:*

College of DuPage WebsiteThe Courier (COD Newspaper)Assistance League Flyer or PosterSocial Media PostReferred by an Assistance League Partner Agency (select this option to view the agencies)Other

Which Assistance League partner agency referred you:

Name of Last High School Attended:*

High School Name, City, State

Year of High School Graduation or General Education Diploma:*

(YYYY)

Higher Education - Please list all post-secondary institutions attended beginning with the program in which you are currently enrolled or were most recently enrolled (If you have not attended a post-secondary program enter "None" in the first row): *

	Institution	Course of Study/Certificate Program	Dates Attended	Credits Completed	Degree/Certificate Earned
1.
2.
3.
4.

What degree or certificate program are you currently enrolled in, or planning to enroll in, at College of DuPage?*

What sessions are you planning to enroll in? Check all that apply.*

Fall 2025Spring 2026Summer 2026

Total Credit Hours still needed to complete your current COD degree/certificate program:*

Total Credit Hours you will need to complete the COD degree/certificate program that you plan to enroll in:*

List any honors, activities or volunteer work:

College of DuPage Transcript (may be unofficial):*

Employment History - Please list your last four jobs starting with your current or most recent employer. (If you have not been employed, please enter "None" in the first line.)*

	Employer	Job Title	Beginning Date	Ending Date	Hours Worked per Week
1.
2.
3.
4.

Personal Income:*

Are you providing financial support to others e.g. children, other qualifying dependents, a partner?*

YesNo

Please give details of the support you provide:*

Number of dependents claimed on your most recent tax return (not counting yourself): (If you did not file a tax return, enter 0)*

How are you paying or planning to pay for your education? Check all that apply*

I am paying it myself (with personal income and/or loans, grants and scholarships)I am receiving support from others e.g a parent or partner

Please give details of any support you receive:

Total Amount of Outstanding Student Loans:*

(Enter $0 if you have no outstanding student loans)

Please submit your FAFSA Submission Summary Report showing your SAI score and the Financial Aid for which you are eligible. If you have any questions, please contact scholarship@alcw.org.*

Please submit your Financial Aid Award Letter from COD. If you have any questions, please contact scholarship@alcw.org.

Reference 1 Name:*

First NameLast Name

Reference 1 Job Title:*

Reference 1 Email Address:*

Must be a COD email address or other work email address. It may not be a personal email address.

Reference 1 is:*

A College of DuPage InstructorWork SupervisorCaseworkerOther

Reference 2 Name:

First NameLast Name

Reference 2 Job Title:

Reference 2 Email Address:

Reference 2 is:

A College of DuPage InstructorWork SupervisorCaseworkerOther

The essay is an important part of the scholarship application. Please write a 250-500 word detailed essay that tells your story about why you should be selected to receive a scholarship. Include how you feel a scholarship will help you personally as an individual to achieve your goals. Please describe your educational and career goals. Please include anything that may be unique or special about yourself such as accomplishments, family situations, work or volunteer experiences. This is a time to boast about yourself. Please include any hardships, challenges or obstacles you are facing or have faced. We are looking for evidence of your commitment to your program of study and future career. We are interested in understanding how our scholarship would significantly enhance your chances of completing your program and advancing in your chosen field. Please write this essay in your own words, as our aim is to learn more about you rather than evaluate the quality of your writing.*

0/500

I certify that all information provided in this application is true and correct to the best of my knowledge.*

Date*

Assistance League may take and publish photographs of me in print and on electronic media for any Assistance League purpose. This includes but is not limited to the Assistance League Chicagoland West website (www.alcw.org), social media, and any other informational or promotional materials. I hereby waive and release for myself all claims for any compensation for such use of pictures, and I hereby indemnify and hold the above organization harmless against any and all claims or damages arising out of use of my pictures or name.*

YesNo

I agree to allow Assistance League Chicagoland West to use excerpts from my essay for use in informational and promotional materials. I understand that such excerpts will be posted anonymously--my name will not be used.*

YesNo

Signature*

Date*

Date

Scholarship Application

Personal Information

Education

Employment and Financial Information

References

Essay

Signature and Consent Form

Photo Consent