scholarship application

Application Information

Please complete all the following fields and "Submit" when complete.
If you have any questions please email Julie Lowery at scholarship@awtca.org

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Telephone* (999-999-9999)

Your Email*

Preferred Method of Contact

Education

University/College

Major

Graduation Date (mm/dd/yyyy)

Overall GPA

If recent High School graduate

High School

GPA

Experience (Work, community service, educational organizations, etc)

Organization 1:

Dates (mm/dd/yyyy):

Description of Activities:

Contact Name:

Contact Phone (999-999-9999):

Organization 2:

Dates (mm/dd/yyyy):

Description of Activities:

Contact Name:

Contact Phone (999-999-9999):

Organization 3:

Dates (mm/dd/yyyy):

Description of Activities:

Contact Name:

Contact Phone (999-999-9999):

Organization 4:

Dates (mm/dd/yyyy):

Description of Activities:

Contact Name:

Contact Phone (999-999-9999):

Application Topics (Select 2 of 4 below, 400 - 800 words each)

1. How does studying Technology fit into your future career goals and passions?
2. Discuss a special accomplishment / attribute in technology that sets you apart from other applicants.
3. Describe how you would like to make a difference and how your college plans (and the Scholarship) can help you on your journey.
4. Tell us about you: Why did you choose Technology? Why is the scholarship important to you?

USE OF INFORMATION: The information and materials provided in this application and on Applicant's behalf will be used by AWT for the purposes of evaluating the application initially, creating a press release, and/or used for research, educational or any other purpose not otherwise prohibited by law. Applicant’s participation constitutes permission for AWT to use Applicant’s information in the in the aforementioned manner and to share the Applicant’s information with any of its partners (for scholarship fulfillment and future marketing programs). By my signature below, I consent to the use of such information for this purpose and hereby confirm and represent that I have obtained any and all authorizations, consents or waivers required for such use by AWT.

Initials*

USE OF PHOTO AND LIKENESS: By my signature below, I hereby consent that if selected to receive this award, I agree to my name, photos, likenesses, video, and/or images to be used in any media, including without limitation on the Internet and in social media, for advertising, promotional and publicity purposes in relation to this program without prior written consent or compensation but the photo will not be requested unless you are selected.

Initials*

RELEASE: By my signature below, on behalf of myself, my parents, spouse and/or assigns, I hereby release, discharge, and hold harmless, AWT and the Board of Directors, mentors, employees, agents, successors, and representatives from any and all claims or damages arising out of, in any way, their participation in this program.

Initials*

APPLICANT'S CERTIFICATION. In submitting this application, I certify that information provided is complete and accurate to the best of my knowledge and that the essay is my own work. I understand that I will be required by the Foundation to provide documentation to corroborate the above information in order to receive scholarship payments. I realize that failure to comply with a request will prevent the applicant from being considered for scholarships and will result in the termination of the scholarship. Further, I certify that I meet the intent and criteria of the scholarship funds that I have applied for as stated in their guidelines. I realize that falsification of information will result in termination of any scholarship granted. I also certify that I do not fit in any of the categories listed below:

  • Current (or within the preceding 12 months) Member of the Board of Directors or the Advisory Board;
  • Employee, intern, or independent contractor (or within the preceding 12 months) of an agency, organization, or institution that partners with, sponsors, or otherwise has a financial relationship with AWT;
  • Spouse, lineal descendant (child or grandchild by blood, legal adoption, or marriage without adoption), spouse of lineal descendants, or ancestor (parent or grandparent by blood) of person(s) in the above categories;

I further agree that if I become aware of any information that might indicate that this disclosure is inaccurate or that I have not complied with this policy, I will notify AWT immediately.

I hereby understand that if chosen as a scholarship winner, according to the AWT Foundation, I must provide evidence of enrollment/registration at the post-secondary institution of my choice before provide scholarship funds can be awarded.

Signature* (Please type your name)

Date (mm/dd/yyyy)

Signature of parent or guardian if under 18 years of age

Date (mm/dd/yyyy)

Relationship to Applicant

Contact Information (Email or Telephone)

Submit Application