River City Scholarship Application

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Page 1

Applicant Information

First Name

Middle Initial

Last Name

Birth Date (mm/dd/yyyy)

Street Address

Apartment/Unit #

City

State

Zip Code

Phone

Your Email

Parents' Name

Parent's Phone

Parent's Email

Education

High School

From: Year

To: Year

Did you graduate?

YesNot yet

If no, current grade:

School using the scholarship funds:

Current or prospective major:

Have you received a scholarship from River City previously?

YesNo

If yes, Year(s) and amount(s):

Page 2

References

Please provide two personal reverences: one from your current school and one from River City.

School Reference

Full Name

Their e-mail

Relationship at school

Their Phone

River City Reference

Full Name

Their e-mail

Relationship at River City

Their Phone

Financial Information

Please answer the questions below about your expenses and income to the best of your knowledge.

Expenses

What is the cost of tuition?

What is the cost of room and board?

What are your other costs? (books, technology, transportation, etc.) Tell us what you'll need to successfully complete your school year?

What is the estimated amount of those other costs?

Income

What is the amount of scholarships or grants you will receive? (e.g. financial aid that you will NOT need to repay)

What is the amount of loans you will receive? (e.g. financial aid that you WILL need to repay)

What is the amount you will earn through employment? (e.g. either working on-campus or another job)

Any other income you receive that's
not already listed?

Tell us about your income sources. How are you finding the funds to pay for school?

Page 3

Essay

Applicants are required to submit a personal essay- this can be done within this document, or by uploading a pdf file of your essay into this form.

Please write a 500 word essay. Please outline your upcoming goals for the school year. You may select 3 of the 6 areas below as an area for focus:

Educational
Financial
Personal
Spiritual
Relational
Physical

Option 1: Upload PDF file of essay here:

Option 2: Copy and paste your completed essay here.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

Yes

If this application leads to my being awarded a scholarship, I understand that false or misleading information in my application or interview may result in River City rescinding the scholarship.

I understand

Before clicking submit- feel free to review for any errors.

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