Clone of Al Hurvis/ADAMM Education Foundation Heiser Scholarship Application- Spring 2019

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You must submit all required information by the deadline of Friday, April 26, 2019 by 5:00 PM to be considered for a scholarship. You can find a list of all questions and required information at www.hurvisadamm.com/scholarships. Please make sure that you have all the information before beginning this application, as you will not be able to save and come back to it.

You will be notified shortly if you are selected to interview in front of the selection committee. Interviews will take place in mid-May 2019.

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Full Name* This field is required.

First Name

Last Name

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Birthdate:* This field is required.11/11/2000

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Phone Number* This field is required.

Type: Cell or home phone?

Phone Number

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Email* This field is required.

example@example.com

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High School you attend* This field is required.

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Cumulative Grade Point Average (GPA)* This field is required.

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ACT Scores* This field is required.

Composite

Math

Science

English

Reading

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Which family member(s) work at Heiser? Please list their name and relationship to you.* This field is required.e.g. Mike Smith, Uncle

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What Extra Curricular Activities have you participated in?* This field is required.

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What offices have you held in school activities?* This field is required.

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What honors or awards have you received?* This field is required.

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What community or other activities have you participated in outside of school?* This field is required.

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What work experience do you have?* This field is required.Please include average hours per week, duties, how long employed

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Are you a first generation college student ?* This field is required.

Yes, I am the first among my parents or grandparents to attend college.

No, either my parents or grandparents have attended college.

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What colleges have you applied to? Have you been accepted yet?* This field is required.

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What are you interested in studying in college?* This field is required.

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What scholarships have you applied for? What other scholarship programs are you involved with (i.e. People Program, Chancellor's Scholarship, etc.)?* This field is required.

0/300

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Father's Information* This field is required.

Name

Employer

Occupation

Annual Income

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Mother's Information* This field is required.

Name

Employer

Occupation

Annual Income

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Other family income* This field is required.i.e. Child Support, family maintenance, interest, etc.

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Does your family own a home?* This field is required.

Yes

No

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Does your family own any other property?* This field is required.

Yes

No

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Please list brother(s), sister(s), and their ages* This field is required.

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How many children in your family are in:* This field is required.

Elementary and Middle School

High School

College

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Please describe other circumstances (medical expenses, health concerns, employment problems, language barrier, etc.) that make it difficult for your family to contribute to college expenses and tuition* This field is required.

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What are your dreams and future goals? How would this scholarship help you achieve those dreams and goals?You may attach your document here or paste it on the next question

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Max. file size: 10.6MB

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What are your dreams and future goals? How would this scholarship help you achieve those dreams and goals?If you did not attach your essay prior, please paste it here

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Please attach your letter(s) of recommendation:Your letter of recommendation must come from a current high school teacher or guidance counselor who can speak to the applicant's current academic abilities and their interest in pursuing post-secondary education.

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Max. file size: 10.6MB

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Please attach your High School Transcript:

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Max. file size: 10.6MB

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Please attach a completed Signature Page (signature page can be found at www.hurvisadamm.com/scholarships):

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Max. file size: 10.6MB

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Please attach a completed Photo Release Form (Release can be found at www.hurvisadamm.com/scholarships):

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Max. file size: 10.6MB

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Any other documents you would like to share with us:

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Max. file size: 10.6MB

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Please verify that you are human* This field is required.

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Thank you for applying for the Al Hurvis/ADAMM Education Foundation Heiser Scholarship!