Scholarship Application Form

Scholarship Application Form

This Scholarship Application Form (“Form”) is issued by [Scholarship Provider/Organization Name] (“Sponsor”) for the purpose of evaluating applicants for the [Scholarship Program Name]. By submitting this Form, the undersigned applicant (“Applicant”) certifies that all information is true and authorizes verification as described below.

1. Applicant Information

Full Legal Name: [First Middle Last]
Date of Birth: [MM/DD/YYYY]
Current Address: [Street, City, State/Province, Postal Code, Country]
Phone: [Number]
Email: [Address]
Citizenship/Residency (if relevant): [Country/Status]
Student ID (if applicable): [ID]

2. Educational Background

Current School/Institution: [Name]
Level of Study: [High School / Undergraduate / Graduate / Other]
Major/Field of Study (intended or current): [Field]
Expected Graduation Date: [Month/Year]
Cumulative GPA (scale): [GPA]/[Scale]
Standardized Tests (if required): [Test, Date, Score]
Unofficial Transcript Attached: [Yes/No]
Official Transcript Requested To Be Sent By: [Date]

3. Academic Honors and Activities

Honors/Awards:

• [Honor 1, Date, Issuer]

• [Honor 2, Date, Issuer]

  
  Extracurriculars/Leadership/Community Service:

• [Role or Activity, Organization, Dates]

• [Role or Activity, Organization, Dates]

4. Financial Information (if need-based)

Household Size: [Number]
Estimated Annual Household Income (currency): [Amount]
Applicant Annual Income (if any): [Amount]
Notable Financial Circumstances (optional brief statement):

• [Circumstance 1]

• [Circumstance 2]
  FAFSA/Local Aid Application Submitted (if applicable): [Yes/No] on [Date]
  Supporting Financial Documents Attached (e.g., tax returns, statements): [Yes/No]

5. Program-Specific Eligibility

Eligibility Criteria Checklist:

• Enrolled or accepted at [Institution type/region requirement]

• Field of study meets program focus [Yes/No]

• Minimum GPA met [Yes/No]

• Residency or citizenship requirement met [Yes/No]

• Other criteria: [Describe]

6. Essay Prompts

Primary Statement (max [X] words): Describe your academic goals and how this scholarship will support them.
Secondary Prompt (choose one, max [Y] words):

• An experience that shaped your commitment to your field

• A community challenge you addressed and its impact

• How you will contribute to the Sponsor’s mission

7. Work Experience (optional)

Employment/Internships:

• [Employer, Role, Dates, Key responsibilities]

• [Employer, Role, Dates, Key responsibilities]

8. Recommendations

Recommender 1: [Name, Title, Institution/Company, Email, Phone]
Recommender 2 (if required): [Name, Title, Institution/Company, Email, Phone]
Recommendation Method: [Upload / Email link / Portal]
Deadline Provided to Recommenders: [Date]

9. Required Attachments

• Resume or CV

• Transcript(s)

• Financial documentation (if applicable)

• Portfolio or research sample (if applicable)

• Proof of enrollment or acceptance letter

• Government-issued ID (if required by Sponsor)

10. Data Use and Consent

The Applicant authorizes the Sponsor and its reviewers to verify academic records, financial information, and references solely to evaluate eligibility and make award decisions. Information will be handled in accordance with [Sponsor] privacy practices and applicable law. Non-identifying data may be used for reporting and program improvement.

11. Certification and Declarations

By signing below, the Applicant certifies that:

• All information provided is accurate and complete to the best of their knowledge.

• Essays and materials are the Applicant’s original work.

• The Applicant will promptly notify the Sponsor of any material changes (e.g., enrollment, GPA, financial status).

• If selected, the Applicant agrees to comply with award conditions, which may include maintaining academic standing, submitting progress updates, or attending recognition events.

12. Award Payment and Conditions (for selected recipients)

Awards may be paid directly to the institution for tuition, fees, and approved educational expenses, or to the Applicant as permitted by program rules. Continued eligibility may require maintaining a minimum GPA, full-time status, or specific program participation. The Sponsor reserves the right to verify ongoing eligibility and adjust or revoke awards for noncompliance or misrepresentation.

13. Non-Discrimination

The Sponsor evaluates applications without discrimination based on legally protected characteristics and commits to fair, inclusive selection practices aligned with applicable laws and program goals.

14. Submission and Deadlines

Submission Method: [Online portal / Email / Mail]
Application Deadline: [Date and Time with Time Zone]
Recommendation Deadline: [Date]
Decision Notification Target: [Date]
Contact for Questions: [Email/Phone]

15. Applicant Signature

Applicant Signature: ____________________________
Printed Name: __________________________________
Date: _________________________________________

Parent/Guardian Signature (if Applicant is a minor): ____________________________
Printed Name: __________________________________
Date: _________________________________________

16. Sponsor Use Only

Application ID: [ID]
Date Received: [Date]
Completeness Check: [Pass/Needs Info]
Reviewer Assignments: [Reviewer names or codes]
Score/Outcome: [Record per rubric]

17. Optional Addenda

Addendum A: Supplemental Questions for Specialized Tracks (e.g., STEM, Arts, Community Leadership)
Addendum B: Portfolio Guidelines (file types, size limits, links)
Addendum C: Budget Worksheet (projected educational expenses and funding sources)

18. Acknowledgment of Instructions

The Applicant confirms they have reviewed the instructions, eligibility criteria, and rubric (if provided), and understands incomplete or late submissions may not be considered.

19. Governing Terms

This Form and application process are governed by the program rules published by the Sponsor for the relevant cycle. Nothing herein constitutes a guarantee of award; decisions are at the Sponsor’s discretion consistent with stated criteria.

20. Checklist (for Applicant)

• Completed all fields in Sections 1–8

• Attached all items listed in Section 9

• Signed Section 15 (and parent/guardian if required)

• Submitted by the deadline in Section 14