The application is open annually from October 1st – March 15th. Applications submitted after March 15th will be considered for the next academic year.

Visit the eligibility & guidelines page for more information and for a printable version of the application or to view the questions prior to completing the online application.

- Step 1 of 7

Institution Attended During the 2023-2024 School Year (select from dropdown) *College/University/Trade SchoolAlburnett High SchoolAnamosa High SchoolBelle Plaine High SchoolBenton Community High SchoolCedar Rapids HSAPCedar Valley Christian SchoolCedar Valley Christian SchoolCedar Valley Christian SchoolCenter Point/Urbana High SchoolCenter Point/Urbana High SchoolCentral City High SchoolDurant High SchoolJefferson High SchoolKennedy High SchoolKennedy High SchoolLinn-Mar High SchoolLinn-Mar HSAPLisbon High SchoolMarion High SchoolMarion HSAPMetro High SchoolMidland High SchoolMonticello High SchoolMt Vernon High SchoolNorth Cedar High SchoolNorth Linn High SchoolPrairie High SchoolScattergood Friends SchoolSpringville High SchoolTipton High SchoolVinton/Shellsburg High SchoolWashington High SchoolWest Branch High SchoolXavier High School

College/University/Trade School Presently Attending *

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Name *

First

Last

Email *

Please use personal email and not a school provided email (ex. gmail.com)

Phone *

Address *

ex. 123 Main St NW #1

City *

State *Iowa

Zip Code *

GPA (based on 4.0 system) *

List participation in school extracurricular activities: *

List participation in other activities (church, scouts, community, etc): *

Honors/Awards Received: *

Are you currently or have you been employed? *

• Yes
• No

Please explain employment history: *

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Guardian 1 *

First

Last

Guardian's Relationship to Applicant *

Occupation *

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Guardian 2

First

Last

Guardian's Relationship to Applicant

Occupation

Phone

Email

Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

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Total Annual Household Income (applicant and guardian(s) combined) *

• Below $20,000
• $20,000 - $40,000
• $41,000 - $60,000
• $61,000 - $80,000
• $81,000 - $100,000
• Over $100,000

Other Financial Resources Received or Expected to Receive *

Number of Younger Siblings *

Number of Older Siblings *

Number of Siblings Attending Higher Education Next Year *

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Field(s) of Study *

Factors that influenced your decision to pursue the above field(s) *

I have applied or plan to apply to the following Iowa institution(s) for higher education: *

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Keeping in mind that this scholarship is awarded based on need and not merit, in your own words, tell us why you qualify for this scholarship. Any information provided remains confidential and is only shared with the committee and matched donor. *

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By typing my full name below, I certify that the information contained in this application and all other materials submitted by me for consideration of this scholarship are to the best of my knowledge accurate and true. I also certify that the personal statement is my own work. *

Submit