Scholarship Application Form 1Name & Schooling2References3Recognition & Experience4Essay & Signature Name(Required) First Middle Initial Last GenderEmail(Required) Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of Residence(Required)Richland CountyCrawford CountyGrant CountyIowa CountySauk CountyVernon CountyOtherOther CountyDo you have a family member who is a UW – Richland Alumnus? Yes No Please indicate – (i.e. Parent, Grandparent, Aunt, Uncle, Sibling, etc.)Present Status as a Student High School Home Educated College Adult Student I will graduate fromI plan to attendMajoring InI plan to attendMajoring inI am enrolled atMajoring InCompleting which year at this school?Semester1st Year2nd Year3rd Year4th YearHave you previously attended College? Yes No I graduated fromI attendedMajoring InCompleting which year at this school? List 3 ReferencesList three references (if you are a high school student, one must be your school counselor or principal).Reference 1NameEmail OccupationPhoneReference 2NameEmail OccupationPhoneReference 3NameEmail OccupationPhone Scholarship Application Form – Part IISelection will be determined by a committee based upon the following criteria:All school awards/activities/recognition/leadership:Non-school awards/activities/recognition/leadership:Work experience: Short EssaySubmit a short essayPlease submit a short essay (150-200 words or less) regarding your financial needs and your career/educational goals.Official TranscriptMax. file size: 100 MB.Please obtain and upload an official transcript. * High School students – apply but submit the transcript and letters of recommendation to your counselor.We begin accepting applications on January 1st. The deadline is March 1st.SignaturePhoneThis field is for validation purposes and should be left unchanged.
