Scholarship Application

Photographer: Mark Iwig of Johnston, IA

First Name*
Last Name*
Email*
Address*
Street Address City State ZIP Code
Phone*
Best time to call*
- Morning
- Afternoon
- Evening
Age
Date of Birth*
MM slash DD slash YYYY
Current GPA*
Current Class Rank*
ACT Score*
SAT Score
Current High School*
High School Principal’s Name*
Principal’s Phone or Email*
Where do you plan to attend college, vocational or trade school?*
School/College City
Intended major(s)*
List your top 3 career goals*
List your community involvement (volunteer work, clubs, etc.) with total hours worked and type of projects worked on for each during the past year*
Organization Project Hours
Please write, or copy and paste your essay of 300-500 words:*
FOR YOUR ESSAY, CLEARLY EXPLAIN: 1) Why you are applying for this scholarship 2) How you plan to use it in your college study 3) How you have developed these goals through high school 4) What you have done, are doing and plan to do for community enhancement and/or the environment – identify any Keep Iowa Beautiful programs you might have been involved with.
How did you hear of these Keep Iowa Beautiful scholarship opportunities? Select all that apply*
- High school guidance counselor
- High school teacher
- Through a County Conservation staff member
- Facebook or other social media
- Keep Iowa Beautiful website
- Local newspaper
- Referral by a friend/family member
Terms and Conditions*
I hereby certify that the information I have submitted as correct. I authorize the release of this information to members of the Keep Iowa Beautiful Scholarship Committee and will provide additional information or verification upon request. If granted the scholarship, I agree to the publication of my name and likeness by Keep Iowa Beautiful. I agree to the conditions established for this scholarship award by Keep Iowa Beautiful. I understand that this scholarship award is contingent upon the financial support of Keep Iowa Beautiful; and that Keep Iowa Beautiful is not responsible for any financial liability.
- I agree to the terms and conditions
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Organization	Project Hours