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ROGERS COMMUNITY BASED SCHOLARSHIP APPLICATION
2015-2016
DEADLINE DATE: THURSDAY, OCTOBER 22, 2015
SIGNATURE PAGE
Name: _________________ _________________ ________________________ Name preferred: _________________
Please Print: first
middle
last
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY. Your signature and the signature of a parent or guardian will
indicate that you have read and understood this information. Signatures of BOTH parent or guardian AND student are
necessary for application to be valid and complete.
Student Certification:
I certify that, to the best of my knowledge, the information on this application is accurate and complete and that the
signatures on this page are valid. I understand that should either signature be found invalid, my application will be
removed from consideration for any community based scholarships. I also certify that both my parent or guardian
and I understand that the information contained in this application will be made available only to the donors that I
request it be given to, including all information on my transcript.
Student’s Signature (Required) ________________________________________________________________________
Statement of Parent or Guardian:
(REQUIRED)
Please share why you feel your son or daughter should receive a community scholarship. You may include any
information regarding your financial situation or family circumstances that you are comfortable sharing with donors.
This statement will be kept as confidential as possible. However, your signature and that of your child will indicate
your permission for the release of any information on this application to those who are awarding those scholarships
your student applies for. If you need additional space, please attach it to this page.
Parent or Guardian’s Signature (Required) ________________________________________________________________
Parent or Guardian’s Email Address (Optional) _______________________________________________________________
IMPORTANT INFORMATION:
This application will be kept on file in the Scholarship Office and NOT given to any scholarship donors until such time as your
student informs the Scholarship Coordinator of the specific scholarship(s) he/ she would like to be considered for.
Check the scholarship list weekly. New scholarships are added each week. When your student sees a community
scholarship that he/she qualifies for and is interested in applying, he/she MUST visit the scholarship office to submit his valid
application for that scholarship. Failure to notify the scholarship coordinator of each scholarship the student would like to
apply for results in the student not being considered for that community scholarship. See your Scholarship Coordinator for
more information.