The application is open annually from October 1st – March 15th.

Please review the eligibility & guidelines page prior to completing the application. One the eligibility & guidelines page, you will also find a printable version of the application in the event you prefer to complete a hard copy, or would like to view the questions prior to completing the online application. Should you have any questions or technical issues while completing the either version of the application, please send an email to [email protected].

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Institution Attended During the 2024-2025 School Year (select from dropdown) *Select OneCollege/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 SchoolIsaac Newton Christian AcademyJefferson 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 a personal email (ex. gmail.com) and not a school provided email (ex. crschools.us).

Phone *

Address *

Please include apt or unit number, if applicable. (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

— Select state —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

— Select state —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 *

This could be grants, scholarships, loans, etc.

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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This scholarship is intended for students who have faced significant hardships in their lives, such as emotional, mental, familial, financial, or other challenges. In your own words, please share your story and explain how these experiences have impacted you and your ability to pursue higher education. We want to understand why this scholarship would make a difference for you. Rest assured, your answer will remain confidential and will only be shared with the scholarship committee and the donor supporting your scholarship. *

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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. *

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