Arkansas Tech University Foundation
Scholarships Application
Development Office | Arkansas Tech University | Admin Bldg 209 | Russellville, AR 72801-2222 | 479-968-0400 | development@atu.edu
INSTRUCTIONS: Complete the current FAFSA (Free Application Federal Student Aid) at www.fafsa.ed.gov. The Arkansas Tech code is 001089.
When need is a determining factor for a scholarship, FAFSA results must be available in the ATU Financial Aid Office for the application to be
considered. Documentation for all applications must be received by February 28 and include a letter from the applicant explaining the need for the
scholarship, special family circumstances, and career goals; three letters of recommendation from high school counselor, principal, teacher, Arkansas
Tech faculty (current Tech students only), pastor, employer, or someone familiar with your work ethic and family situation.
Return completed application and all supporting documents to: Arkansas Tech University Foundation, Office of Development, Scholarship
Administrator, 1509 N Boulder Avenue Adm. 209, Russellville, Arkansas 72801-2222, no later than February 28.
Date of Birth: ________________________________________
Student ID: T _________________________________
Legal Name: Please print.
First:____________________________________ Middle:___________________________________
Last: ___________________________________
Permanent Mailing Address:
Street Address or PO Box: ____________________________________ City: ________________________________
State:______
Zip: ___________
Home Number: (_______) __________________________ Cell Number: (________) __________________________ County: ________________________
Email Address: __________________________________________________________________
For year of application, I will be:
_____ Entering Freshman
_____ Freshman
_____ Sophomore
_____ Junior
_____ Senior
Have you declared a major: ________ If yes, please list major and area of interest:____________________________________________
Are you planning to be a full time student: ______ Do you plan on remaining in Arkansas after Graduation: __________ Are you married: _______
Are you a single parent: ________ Are you from a single parent family: _______
Number of family members at home (include yourself): ______ How many in the immediate family will be attending college (include yourself): _____
Do you speak more than one language: _____ If yes, what language: ______________________________________
Did any of your family members graduate from Arkansas Tech: _____ Father ____ Mother _____ Brother _____ Sister
If so, please list names: _______________________________________________________________________________________________________
Are you receiving any other scholarships: _______ If so, please list: ____________________________________________________________________________
For the next four questions, please attach additional page(s) with your detailed answers.
1.
2.
3.
4.
Give a brief description of clubs, leadership positions, honors, awards, achievements, and community or campus involvement that you would like the
selection committee to know.
What are your career goals and how do you plan on achieving them?
Please list any special circumstances in your family that you feel should be considered by the selection committee.
Express what this scholarship means to you and how you feel it will assist you while you are at Tech.
I certify that the information above is true and correct to the best of my knowledge. I understand that my application will be considered for all scholarships for which I fulfill the
criteria requirements through the Arkansas Tech University Foundation. By signing this application, I authorize Arkansas Tech University Foundation employees and selection
committees to access student records, FAFSA information, etc., as well as to distribute the completed application and disclose the information therein to members of the
scholarship committee, other campus departments, the donor or a family representative.
Application will not be considered without a signature.
Applicant’s signature: ____________________________________________
Date: _____________________________
The Arkansas Tech University Foundation is committed to the policy of providing equal opportunity for all persons and does not discriminate in scholarship recipient selection on the basis of sex,
disability, age, race, veteran’s status, national origin, or religion.