Ethnicity/Race:^*
Based on US Census Bureau options

Asian

African American/Black

Hispanic/Latino

Native American

Pacific Islander

White

Prefer not to state

EDUCATIONAL STATUS

Please select all that apply to your current status:^*

A former eSMART Camper

Continuing Scholar - Traditional

Continuing Scholar - Non-Traditional

An Adult-Ed Graduate

Other

If you selected "other" above please describe:

What year will you be in next fall?

Freshman Sophomore Junior Senior Graduate

If "Graduate", in what area of study?

How many credit hours do you plan to take next fall? ^*

Full Time Student (12+ credit hours per semester)

Part Time Student (minimum of 6 credit hours per semester)

What is your most recent College GPA? ^*

If applying as incoming freshman, GED or HIgh School documentation is required.

Schools attended beginning with last year of high school. ^*

School Name

Location

Dates of Attendance

ACTIVITIES, HONORS, AWARDS ^*

Please list your community involvement, volunteer activities, as well as an honors, awards, or special recognition that you have received.

LIFE & EDUCATIONAL ACHIEVEMENT GOALS (300-500 words) ^*

Please describe your goals, primary motivation for achieving a degree or certificate, and include any information you feel would be appropriate for consideration by the selection committee.

FINANCIAL INFORMATION ^*

Scholarships are awarded on the basis of financial need and ability to complete your degree. Your FAFSA results validate your financial need and is required to apply for this scholarship. If you have not applied, please do so immediately at Free Application for Federal Student Aid. (Link will open in a separate browser window.)

Have you applied for other financial assistance programs, i.e., a Pell Grant?

If so, please list blow

Financial Program Name

Date Applied

Amount Awarded

Employment Information

List your most recent jobs from most recent, to older.

Title/Position

Employer

Location

Dates of employment

Do you have a spouse?

Yes

Spouse's Occupation

Number of dependents

Number of people in your household ^*

What was your gross household income LAST year? ^*

Please check one.

Less than $10,000

$10,000 - $19,999

$20,000 - $29,999

$40,000 - $49,999

more than $50,000

What is your expected gross income for the year of this application? ^*

Please check one.

Less than $10,000

$10,000 - $19,999

$20,000 - $29,999

$40,000 - $49,999

more than $50,000

Talk about how you plan to finance your education, including any outstanding college loans of financial challenges

SUPPORTING DOCUMENTS

All documents required at time of submission. No applications will be accepted after March 4, 2021.

Please upload the following files in a PDF or WORD format. Your school transcripts must have your name and student ID number on each page. (If you are a Dixie student - go into your Dixie account on "My Dixie" and login and order official transcripts electronically through the Dixie website).

Current Transcript must have college 2.5 GPA

All the information provided in my application is true and accurate to the best of my knowledge.

I Agree. Date Submitted: 01/26/2021

Scholarship Application Form

Contact Information

EDUCATIONAL STATUS

FINANCIAL INFORMATION ^*

Employment Information

SUPPORTING DOCUMENTS

Scholarship Application Form

Contact Information

EDUCATIONAL STATUS

FINANCIAL INFORMATION *

Employment Information

SUPPORTING DOCUMENTS

FINANCIAL INFORMATION ^*