AOL Scholarship Application Form

Financial Aid for Adventures Online
NOTE: This is the scholarship application for Adventures Online. If you would like to apply for an in-person experience, please apply here.

Instructions

Please read through this form carefully. In order to submit this form, you will need to upload a copy of your financial documentation.

You will also have an opportunity to select up to three (3) Adventures Online programs towards which to apply your scholarship. See the full list of open Adventures Online.

If you have any questions regarding Financial Assistance, please email scholarships@roadscholar.org.
I. Personal Information

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Phone No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*

MaleFemalePrefer not to answer
Are you...*

MarriedDivorced or separatedWidowedSingle, never marriedPrefer not to answerOther
Race

Native American or Alaska NativeAsianBlack or African AmericanPacific Islander or Native HawaiianWhitePrefer not to answerOther
Ethnicity

Hispanic or LatinoNot Hispanic or LatinoPrefer not to answer
Employment Status*

Employed full-timeEmployed part-timeSelf-employedDisabledHomemakerRetiredPrefer not to answerOther
Please tell us your current or most recent profession/ occupation:
How did you learn about Road Scholar?*
Please use this space to indicate up to three (3) program choices and dates. Please only choose from the current list of upcoming Online Adventures (see link above).
Do not list in-person programs. We will do our best to accommodate as many of your selections as possible.
II. Financial Information

All information will be kept strictly confidential.
Total household income last year*
Include all sources of income, including salaries, wages, interest, IRA distributions, pensions, and gross Social Security benefits.
Did you file an income tax return for the previous year?*
If yes, please upload pages 1 & 2 of your most recent federal income tax filing. If no, please upload a copy of your most recent Social Security Benefit statement.
Please upload a copy of your financial documentation. *

You may also email it to scholarships@roadscholar.org.
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III. Personal Statement
Please tell us why you are requesting financial assitance to participate in an Road Scholar Adventure Online. If applicable, please include as many details as possible about:
- Income challenges (current income sources, employment or income changes, layoffs, reasons for early retirement or part-time work).
- Caregiver responsibilities, if you are a caregiver (person for whom you care, how long you have been a caregiver, your daily care-giving responsibilities).
- Medical expenses (expenses incurred by you, a spouse, a dependent or a loved one for whom you are caring).
- Emergency or temporary expenses (economic hardships resulting from catastrophic events, natural disasters, accidents, funeral expenses, etc.).
- General challenges that constrain your monthly income or budget (i.e. barriers to working such as disability, lack of transportation, family obligations).
- Any other expenses or circumstances that you would like the Financial Assistance Committee to consider.
Please enter your personal statement here:*

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IV. Applicant's E-Signature
By signing the space below, you are agreeing to abide by the terms and conditions of the Financial Assistance program below:
- You are certifying that all information is correct.
- You agree that if selected, the scholarship cannot be transferred to another person.
- You agree to complete a program evaluation upon completion of the program.
- You are required to write a thank-you letter to the donor(s) in care of the Road Schoalr Financial Assistance Committee within 90 days of the completion of the program.
- You will allow Road Scholar to use your personal statement and thank-you letter in reporting to our donors and the public at large, including how donations to Road Scholar are being used, and to be identified in those materials by your first name, last initial, city and state (e.g., Mary S., Omaha, Nebraska).
Your financial and contact information will always remain confidential.
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Financial Aid for Adventures Online

Instructions

I. Personal Information

II. Financial Information

III. Personal Statement

IV. Applicant's E-Signature