Scholarship Application

Personal Information

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• Alive CU Member Number
  OK Alive CU Member Number is required
• Phone Number
  OK Phone Number is required
• Email
  OK Email is required
• Address
  OK Address is required
• Attending (Name of Accredited Institution)
  OK Attending (Name of Accredited Institution) is required
• Institution's Address
  OK Institution's Address is required
• Major/Certification being pursued
  OK Major/Certification being pursued is required
• Please list any academic honors received
  OK Please list any academic honors received is required
• Please list your community involvement
  OK Please list your community involvement is required
• Paste your minimum 300-word count essay to the Current Essay / Video Prompt here. Video submissions should be sent to [email protected].
  OK Paste your minimum 300-word count essay to the Current Essay / Video Prompt here. Video submissions should be sent to [email protected]. is required

• Please email the following items to [email protected]:

  • One letter of recommendation
  • Recent college transcript or high school report card
  • Video (if applicable)
  OK Please email the following items to [email protected]: is required
• • I certify that the information included in this application is true and correct. I understand that my submission will not be considered if I have not fully completed this application, an essay or video on the topic above, a current transcript and one letter of recommendation.
  OK I certify that the information included in this application is true and correct. I understand that my submission will not be considered if I have not fully completed this application, an essay or video on the topic above, a current transcript and one letter of recommendation. is required
• Applicant's Full Name (serves as your electronic signature)
  OK Applicant's Full Name (serves as your electronic signature) is required
• Today's Date (mm/dd/yyyy)
  OK Today's Date (mm/dd/yyyy) is required