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Scholarship Application Form

Scholarship Application Form

Application Deadline is March 1. Applications received after the March 1 deadline may be considered pending availability of funds
*Ask someone who is familiar with your abilities to complete a Scholarship Recommendation Form. As a courtesy, you may wish to use a pre-stamped and pre-addressed envelope to the reference. Return to: ECC Scholarships Student Services Office 1100 College Avenue Iowa Falls, IA 50126-1199 *Ask your high school counselor for a copy of your transcripts *Return the completed Scholarship Application Form and transcript copy to the above address
Type of Scholarship applying for*
- ECC Academic Scholarship
- ECC Ambassador Scholarship
- ECC Director's Scholarship
- ECC Leadership Scholarship
- ECC Meritorious Scholarship
- ECC Career & Technical Scholarship
- ECC Housing Grant
- ECC Legacy Scholarship (please specify below)
- ECC Activity & Athletic Scholarships (please specify below)
- ECC Endowed Scholarships (please specify below)
Description of scholarship type
Name*
First Middle Initial Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Name of High School*
Intended area of study*
Year of Graduation*
Intended ECC Enrollment Term*
Which term will you begin taking classes? Fall (beginning in the upcoming August) or Spring (beginning in the upcoming January)
Intended ECC Enrollment Year*
Student Status*
Parent/Guardian Name*
First Last Occupation
Parent/Guardian Name
First Last Occupation
Other Family Members
First Name Last Name Age
Extracurriculars
Activities and Honors Years of Involvement Leadership Role
What did you gain from your leadership experiences?*
Indicate examples of leadership experience (extracurricular activities, community, or civic), honors received, recognition, etc*
Work Experience
Nature of Job Employer Dates of Employment

Please list all previous experience
Date
Date Format: MM slash DD slash YYYY

First Name	Last Name	Age

Activities and Honors	Years of Involvement	Leadership Role

Nature of Job	Employer	Dates of Employment

Scholarship Application Form

Application Deadline is March 1. Applications received after the March 1 deadline may be considered pending availability of funds

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