Scholarships Application

Information

Name

Address

City/State/Zip Code

Date of Birth

Students Email Address

Students Home Phone

Students Cell Phone

Current School and Grade

Guidance Counselors Name

Guidance Counselors Email Address

How did you hear about the Scholarship Program?

Google or other search engine

Advertising

Guidance Counselor

Friend

A Community Based Agency

Other

For Undergraduate (Graduating High School Seniors)

College or University Name

Intended Major for Academic Scholarship Applications (HS Seniors Only)

College Tuition Cost

Room/Board (if applicable)

Are you a first generation college student?

Yes

No

Are you currently employed?

Yes

No

Parent(s) or Guardian Information

Name

Address

Relationship

Home Phone

Cell Phone

Employer

Additional Parent or Guardian Information (if applicable)

Name

Address

Relationship

Home Phone

Cell Phone

Employer

Required Materials

Please provide the following documents:

2 letters of recommendation

School transcript

Student resume

Copy of income tax (blackout SS number)

Essay: Answer 1 of the following questions.

What challenges have you had to overcome to achieve your goals and pursue your education? How did you overcome those challenges and what did you learn about your own unique leadership capabilities? How will you apply the lessons learned to help you achieve your future goals?
Statement of Financial Need: Describe why you need financial assistance. How will this scholarship help you achieve your goals?
Describe an event, achievement or experience that has had a strong nfluence on your life using one of the DREAMS acronyms (Determination, Realization, Enrichment, Academics, Mission or Service) as a focal point

Please attach/upload all materails in one PDF file here

Upload requirements

Any additional files to be submitted (if applicable)

Upload requirements

Agreement

By clicking the submit button below I attest that all of the information provided in this application is complete, factually correct and honestly presented. I understand that if any of the information is found to be false, this may result in disqualification or forfeiture of the scholarship award. I understand that it is my responsibility to submit appropriate bills to United Way of Long Island for payment that will be made directly to the appropriate academic institution or vendor.

I understand that my submission of this form attests to the above, and I agree to adhere to these terms. If the applicant is under the age of 18 years old, an additional signature of a parent or guardian is required. Please provide signature with material submissions, if applicable.

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