IOWA STATE UNIVERSITY

OF SCIENCE AND TECHNOLOGY

HAMILTON COUNTY I.S.U. ALUMNI ASSOCIATION SCHOLARSHIP

The Hamilton County Alumni Scholarship is awarded annually on the combined basis of need and scholarship.
The amount of the scholarship is $500. One or more scholarships will be awarded based on the amount of
donations from alumni and friends of Iowa State University in Hamilton County, Iowa. While no reference letter
is required, if you feel further explanation of any requested information is necessary, a letter may be attached
to this application. Please submit your completed application, along with a photo to be used for publicity
purposes, so that it is received no later than March 31 annually.

GENERAL INFORMATION:
Applicant’s Name: Age:
(Last) (First) (M.I.)

Home Address:
(Street)

(City) (State) (Zip)

Email Address:

Telephone Number:

University Address (If known):

Grade Level (Fall Semester): Major Course of Study:

FINANCIAL INFORMATION:

Describe any past/present employment of your own: _____________________________________________

________________________________________________________________________________

________________________________________________________________________________

Do you intend to work while in college? ________ Describe: _____________________________________

________________________________________________________________________________

What is the EFC (Estimated Family Contribution) amount as listed on your FAFSA form? _________________________
SCHOLARSHIP (High School):
High School You Attended: ______________________________________________________________________

High School Grade Point Average: Rank in High School Class: _______ out of __________

ACT Composite Score: High School Academic Honors:

_________________________________________________________________________________________________

Participation in Academic Clubs / Organizations:

Participation in Extracurricular Activities:

SCHOLARSHIP (I.S.U.):

When did/do you plan to enter Iowa State University?

What is your anticipated Graduation Date from Iowa State University?

Note: If still in high school, please answer the following based on the activities you think you may participate in while
attending ISU. If already attending ISU, please answer based on the activities you've participated in.

Participation in Academic Clubs / Organizations:

Participation in University Activities:

List any colleges other than Iowa State University that you have attended:

College Cumulative Grade Point Average (if applicable):

Applicant Signature Date

Return Completed Application along with a photo for publicity purposes to: Dan Rader
PO Box 223
Jewell, IA 50130

Interviews are tentatively scheduled for April. You will be notified to set up an interview time.

APPLICATIONS MUST BE RECEIVED NO LATER THAN: March 31 annually.