Applicant Information

Applicant Information
Applicant Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mother/Guardian Name*

First NameLast Name
Father/Guardian Name

First NameLast Name

Personal Reference
Please provide the name, address, phone number and preferred time of day to contact your reference. It is your responsibility to notify your reference that the Scholarship Committee will contact them by phone for comment. Select an adult who knows you through work, volunteerism, or extra-curricular activity, etc.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Financial Data

In order of preference, please list all colleges to which you have applied as well as your intended major and degree. Include the annual cost (tuition, room and board) plus any additional expenses.
*Please note that we will request finalists to also furnish copies of financial aid award letters from accepted institutions prior to interviews.
Intended Major*
Degree*

Please list all colleges and universities to which you have applied.*

	College/University	Cost/Year
1
2
3
4
5
6
7
8

Please list all scholarships for which you have applied.

	Scholarship	Amount
1
2
3
4

Financial Disclosure
Please indicate the anticipated dollar amount you expect to have available each year for tuition, room and board, and books; and the sources of those funds.

Type a question

	Source	Amount
Year 1 - Student Source
Year 1 - Parent Source
Year 2 - Student Source
Year 2- Parent Source
Year 3 - Student Source
Year 3 - Parent Source
Year 4 - Student Source
Year 4 - Parent Source

Please explain any extraordinary expenses or circumstances:
Summer Plans
Please indicate your plans for the upcoming summer, including earnings expectations.

Applicant Undertaking
In signing this application, I understand that I am releasing a copy of my high school transcript including grade point average and ACT/SAT scores to the scholarship committee. Also, should I be awarded funds through the College Woman's Club, I understand that to accept any scholarship funds, I must be a candidate for a baccalaureate degree.

Furthermore, I understand that I must maintain good academic standing to be eligible for College Woman's Club funds. I also understand that my academic progress must be substantiated through a college transcript to this committee each academic semester while receiving College Woman's Club funding. I understand that I must make arrangements for my transcript to be sent by the college registrar to the College Woman’s Club no later than January 15th and July 1st of each academic semester.

Lastly, I attest that to the best of my knowledge, all information furnished in this application, including the FAFSA and tax returns, is true and complete and without exception. If I am an award recipient and do not conform to the policy requirements stated in this Applicant Undertaking, the College Woman's Club can assume that I am not interested in receiving the scholarship funds. I understand that the payments on my behalf will be terminated.
Signature of Applicant*

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Signature of Parent of Guardian (Mother/Guardian)*

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Signature of Parent of Guardian (Father/Guardian)

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Should be Empty:

Applicant Information

Personal Reference

Financial Data

Financial Disclosure

Summer Plans

Applicant Undertaking