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IACLEA Application for Scholarship Award

The completed application must be submitted by March 17, 2017.
In addition to completing the form below, scholarship applicants must submit an essay of 500 words or less addressing their need and why they are deserving of IACLEA scholarship support. The essay and questions about these scholarships and/or eligibility should be emailed to Maddie Gosser at .

Personal Information
Scholarship you are applying for:
Last Name:
First Name:
Middle:
Mailing Address:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Email:
College/University:
Enrollment Status:

Full-time   Part-time

I certify that I have a cumulative 3.0 grade-point average for all college course work to date.
Class Status: Freshman    Sophomore     Junior     Senior
Current/Intended Academic Major:
Degree Sought: Associate  Bachelor   
Other: 
Anticipated Date of Graduation:         
Extracurricular Activities: (Clubs, sports, etc.)
(Note: you may also include high school activities)
Personal Interest/Hobbies: