Scholarship Application

Name

Date of Birth

Gender

Home Address

Phone

Marital Status

High School

School Phone

School Address

City

State

Zip

Graduation Year

GPA

List the colleges you have applied to or intend to apply to:

First Choice

Status

Second Choice

Status

Third Choice

Status

Intended major(s) or interest area(s):

First Choice

Second Choice

Third Choice

Expected Graduation Year

Applicants who are dependent children

Mother's Name

Phone

Cell

Father's Name

Phone

Cell

Sibling's Name(s) and Age(s)

How many in college?

Applicants who are NOT dependent children

Spouse's Name

Phone

Cell

Contact Person's Name (if applicable)

Phone

Cell

How many in college?

Living on campus / off campus?

Applicant's Classification

Since the element of financial need can be one of the determining factors used by the Scholarship Selection Committee in selecting the recipients of the WTAA scholarship awards. It is important that complete and accurate information be supplied. All information, financial or otherwise, furnished to the committee is kept in the strictest confidence by the committee.

Please list any other scholarships or grants that you will receive and the amount of each.

Name

Amount

Name

Amount

Name

Amount

Have you applied for federal financial aid by filing the Free Application for Federal Student Aid (FAFSA)?

Will you be employed while in college?

If yes...

Employer (if known)

Occupation

Number of hours worked per week

Please explain any other circumstance regarding financial need that you would like the Scholarship Committee to know.

Please list any extracurricular school activities or organizations to which you belong, include name, dates, and indicate offices held.

Please list activities or organization outside of school to which you belong, include name, dates, and indicate offices held.

Please list any honors, recognition or awards you have received, include organization name and dates.

List three (3) non-family references and their relationship to you (teacher, employer, clergy, coach, counselor, etc.)

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

May we use your name for publicity purposes on our website, in newsletters, newspapers, etc.?

Name and location of hometown newspaper:

For Applicants with West Tech Connections ONLY
The person with the West Tech connection:

Name

Relationship

May we use your name for publicity purposes on our website, in newsletters, newspapers, etc.?

Applicant’s WTAA Sponsor, if different from the person named above:

Name

Class of (Month and Year)

Phone Number

Essay

Please write a 250-to-500-word essay describing your background, academic goals, career goals, objectives, and other experiences that have contributed to your personal development and future aspirations. Submit the essay with this application.

Essay:

Applicant's Name

Date

Agree to this as signature?

Yes

First time applying for a WTAA Scholarship?

About

History

Contact