2026 Patriot Scholarship Application
Standard scholarship application form. Complete all required fields, preserve the original field names and groupings, and submit the essay within 350–500 words.
Applicant Information
Applicant Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Address
*
State
*
Zip Code
*
Telephone (Home)
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Race
*
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Other
Primary Language
*
English
Spanish
Education and Student Background
High School Name
*
Grade Level
*
Approximate Class Rank
Approximate GPA
Graduation Date
*
-
Month
-
Day
Year
Date
Intended Career/Field of Study
Planned College/University/Trade School
Activities and Involvement (Last 2 Years)
*
Resume Status
Attached
Not Available
Household Information
Total Number of People in Household
*
Number of Adults in Household
*
Number of Siblings in Household
*
Sibling 1 Age
Sibling 1 Grade Level/Status
Sibling 2 Age
Sibling 2 Grade Level/Status
Sibling 3 Age
Sibling 3 Grade Level/Status
Sibling 4 Age
Sibling 4 Grade Level/Status
Sibling 5 Age
Sibling 5 Grade Level/Status
Household Composition
Two parents/guardians
Single parent/guardian
Grandparents
Foster care/other guardian
Elderly family members
Other
Household Composition - Other
Housing Situation
Own
Rent
Live with relatives
Temporary housing
Other
Housing Situation - Other
Parent/Guardian 1 Name
*
First Name
Middle Name
Last Name
Parent/Guardian 2 Name
First Name
Middle Name
Last Name
Parent/Guardian 1 Job Title/Industry
Parent/Guardian 2 Job Title/Industry
Parent/Guardian 1 - Highest Level of Education
Some high school
High school graduate/GED
Some college
College Degree
Graduate/Professional degree
Parent/Guardian 2 - Highest Level of Education
Some high school
High school graduate/GED
Some college
College Degree
Graduate/Professional degree
Annual Household Income
*
Under $25,000
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000+
Computer at Home
*
Yes
No
Reliable Internet Access
*
Yes
No
Access to a Smartphone
*
Yes
No
Military Connection
Parent/guardian is in active duty
Parent/guardian is a veteran
Sibling is in active duty or a veteran
None
First-Generation College Student
Yes
No
Kazen Fellow
Yes
No
How did you hear about the SMW Patriot Scholarship?
School counselor
School announcement
Social media
Friend or family member
SMW event or member
Other
How did you hear about the SMW Patriot Scholarship? - Other
Emergency Contacts
Emergency Contact - Parent/Guardian #1 Name
*
First Name
Middle Name
Last Name
Emergency Contact - Parent/Guardian #1 Relationship to Applicant
*
Emergency Contact - Parent/Guardian #1 Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact - Parent/Guardian #1 Email Address
example@example.com
Emergency Contact - Parent/Guardian #2 Name
First Name
Middle Name
Last Name
Emergency Contact - Parent/Guardian #2 Relationship to Applicant
Emergency Contact - Parent/Guardian #2 Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact - Parent/Guardian #2 Email Address
example@example.com
Certifications and Essay
Applicant Certification - Signature
*
Parent/Guardian Certification - Signature
*
Applicant Certification - Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Certification - Date
*
-
Month
-
Day
Year
Date
Essay Topic Selection
*
Please Select
Achievement & Leadership
Close Up Washington Goals
Patriotism & Civic Responsibility
Community Impact & Service
Challenge & Resilience
Other
Completed application
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Recent photograph
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Resume
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High school transcript
Upload High School Transcript
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Teacher or counselor recommendation letter
Upload Recommendation Letter
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Essay Document
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Submit Application
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