Instructions:
1.Save form to your computer.
2.Fill out in Adobe Acrobat and save.
Len Assante Scholarship Application
3.Email completed form and additional
information to ngwref@ngwa.org.
Full name__________________________________________________________________________________________
Mailing address_____________________________________________________________________________________
Phone number______________________________________________________________________________________
Email address_______________________________________________________________________________________
Birthdate___________________________________________________________________________________________
Are you a U.S. citizen? 
Yes 
No If no, type of visa_____________________________________________________
Name of school you are currently attending or most recently attended________________________________________
GPA at that school___________________________________________________________________________________
Class rank (if applicable)_______________________________________________________________________________
Name of school you are planning to attend at the start of new academic year___________________________________
Proposed field of study_______________________________________________________________________________
Please fill out the table below with a listing of all extracurricular activities that you participated in during the past four
years. Please include paid work, volunteering, sports, clubs, professional societies, etc. on the list. It is important for
the Foundation to understand how your time outside of school was spent. (Attach an additional sheet if necessary.)
Activity
Activity type (work,
Monthly time
volunteer, sports, etc.) commitment
Dates of participation Leadership role
Awards and special recognitions received in the past four years include:
1.________________________________________________________________________________________ 2.________________________________________________________________________________________ 3.________________________________________________________________________________________ 4.________________________________________________________________________________________ 5.________________________________________________________________________________________ Describe the nature of your educational pursuits and your future career ambitions (100 words or less).
Describe the nature of your financial need (100 words or less).
 I affirm the information that I have provided on this application, and any supportive financial aid materials, is
complete, accurate, and true to the best of my knowledge. I understand that furnishing false information may
result in ineligibility for the award.
Applicant’s signature______________________________________________________________________________
Date____________________________________________________________________________________________
Please return the completed application, along with the following required documents, to ngwref@ngwa.org.
 Transcripts (covering the last five years)
 A headshot photo (300 dpi or greater)  Letters of recommendation