Scholarship Application Form

1Name & Schooling

2References

3Recognition & Experience

4Essay & Signature

Phone

This field is for validation purposes and should be left unchanged.

Name(Required)

First Middle Initial Last

Gender

Email(Required)

Address

Street Address City State ZIP Code

County of Residence(Required)

Other County

Do you have a family member who is a UW – Richland Alumnus?

Yes

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 from

I plan to attend

Majoring In

I plan to attend

Majoring in

I am enrolled at

Majoring In

Completing which year at this school?

College Student ID Number

Have you previously attended College?

Yes

I graduated from

I attended

Majoring In

Completing which year at this school?