Scholarship Application Form

Applying for a Scholarship is as Easy as 1, 2, 3!

STEP 1 Questions? Email for Help.
PERSONAL INFORMATION

First Name *

Last Name:*

Current Address:*

City:*

State:*

Zip:*

Daytime Telephone:*

Email:*

Kishwaukee College Student ID # or last four of SSN #: *

Date of Birth: MM/DD/YYYY

Kishwaukee College Student Status:

New Student Returning Student

If you have taken any classes at Kishwaukee College, you must fill out the Transcript Request form.

Instructions:
1) Fill out and sign the form.
2) Submit to the Kishwaukee College Admissions, Registration & Records Department in person or by mail.
3) The form must be received by Admissions, Registration & Records by the scholarship application deadline in order for the request to be processed.
4) Failure to submit this form by the deadline will result in your application being reviewed by the scholarship committee without Kishwaukee College transcripts, which may exclude you from consideration for certain scholarships.

Racial or Ethnic Background:

	American Indian/ Alaskan		Hispanic
	Black/Non-Hispanic		Other
	Asian/Pacific Islander		No Response
	White/Non-Hispanic

FINANCIAL INFORMATION
Please include any income from child support, alimony or any other state or federal assistance. If you are still claimed as a dependent on your parents’ tax return, you must complete all questions referring to income using both yours and your parents’ income, whether they are helping you financially or not. Use gross income for all totals. If you have no income for personal and/or other income field(s), enter “0”.

When entering numbers, do not use commas.

Personal Estimated Annual Income (a):*

Estimated Annual Income of those who claim you on their income tax return (b):*

Total of a+b:*

# of Dependants:

Ages of Dependants:

I am a Single Parent: *

Yes No

Currently Employed:*

Yes No

Average Hours Worked Per Week:

Are you currently receiving State or Federal aid?*

Yes No

Have you completed and turned in your FAFSA Federal Student Financial Aid Form to the Financial Aid Office?*

More help for students in financial need can be found at: www.kishwaukeecollege.edu/paying_for_college/forms.php?page=96

EDUCATION

High School Attended:

City, State, Zip

Graduation Status:

Graduated Will Graduate GED Working on GED

Estimated Graduation/GED Date:

High School GPA/GED Score:*

Anticipated Kishwaukee College Graduation Date:

Anticipated Transfer from Kishwaukee College Date

I Plan To Enroll at Kishwaukee College as a:*

Full Time Student Part Time Student

I Am Currently Enrolled at Kishwaukee College as a:

Full Time Student Part Time Student

Please tell us why you believe you should receive this (these) scholarship(s):

STEP 2 Questions? Email for Help.
CHOOSE SCHOLARSHIPS (you may apply for multiple scholarships)

1) Choose one department by checking the box.
2) Select an area of study within that department from the drop-down menu.
3) View requirements for each scholarship.
4) Select appropriate scholarships by checking the box.

You may apply for multiple scholarships in one area of study, in addition to scholarships in the following categories: Adult Education & Transition Programs, Financial Need, Heritage, Graduates or Attributes. To apply for scholarships in multiple departments / areas of study please contact the Foundation Office at 815-825-2086 ext. 2660.

Art/Communication/Social Sciences

Theater	Tom and Nancy Roberts Theatre Endowment	View Requirements
Theater	Michael Bennett Scholarship for Art	View Requirements
Music	Rufus Brown Memorial Scholarship for Music	View Requirements
English	Arden Perry and Kathryn Cornell Scholarship	View Requirements
English	Jeanne M. Henderson Memorial	View Requirements
Multiple	Richard Akers Family Endowment	View Requirements

Career Technologies

Mathematics/Education/Science/Health

You may also qualify for one of the following scholarships based on criteria other than your area of study.

Adult Education & Transition Programs

Kishwaukee College Foundation Outstanding GED	View Requirements
Stephen P. Irving Family Endowment	View Requirements

High School Graduates

Harold C. Flanigan Memorial Endowment	View Requirements
Vernon & Dorothy Smith Memorial Endowment	View Requirements

Financial Need

Linda Stoltz Caruthers Memorial Endowment	View Requirements
Leah Wach Memorial Scholarship	View Requirements
Veronica M. Ream Endowment	View Requirements
Les & Deanie Springmire Endowment	View Requirements
Kishwaukee College Employee	View Requirements

Heritage

Doris & Robert Boey Asian Heritage Endowment	View Requirements
K.C.F. Hispanic Endowment	View Requirements
The Suter Company Scholarship	View Requirements

Attributes

Bud & Kay Stocking, Rochelle Rotery Endowment	View Requirements
Laverne "Dutch" Johnson Endowment	View Requirements

STEP 3 Questions? Email for Help.
SUBMIT YOUR APPLICATION WITH APPROPRIATE DOCUMENTATION

Attach any supporting documents or statements as identified in the requirement sections of all scholarships you are applying for today. If you fail to attach supporting documentation you may be excluded from consideration for certain scholarships.

ALL letters of reference and/or statements of fact must include the contact information of the author.

To attach a file to your scholarship application, click the browse button. Locate the file on your computer or other media. Click on the file you want to attach, and then click open.

*By sending this form I agree to the following:
I understand that failure to provide requested information may exclude me from consideration for certain scholarships. Should I receive a scholarship, I agree that the donor may receive a copy of my application.

I attest that the information contained in this application and all attached documentation is true and correct. I also authorize Kishwaukee College Foundation to verify the correctness of this information and to procure any other information they may require.

Within the next few days, I will receive an email from the Kishwaukee College Foundation notifying me that my application has been received and processed. This email is the official receipt of my application. I understand that without this receipt, no extensions or exceptions to the application deadlines will be considered.

How did you learn about Kishwaukee College Foundation scholarship opportunities?

	Kishwaukee College website		Kishwaukee College Advisor
	Kishwaukee College Foundation website		Financial Aid Office
	Poster on Kishwaukee College campus		High School Counselor
	TV display on Kishwaukee College campus		Letter from Foundation
	Other: