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Iowa PTA

NEW ADDRESS AS OF JULY 1, 2014

PO Box 10634            Cedar Rapids, IA 52410

FedEx or UPS packages please use this address:

1380 60th Street NE #10634 Cedar Rapids, IA 52410

 

Phone: (319) 573-0049


Office Hours:

Monday, Tuesday, Thursday

9 am - 11 am

Inquiries (phone or e-mail) will be answered/returned during these business hours.  

 

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Scholarship Application

Scholarship Application

Personal Information - all fields with an (*) are required.

First Name (*)

Please enter your first name.
Middle Name

Please enter your middle name.
Last Name (*)

Please enter your last name.
Phone (333) 333-3333 (*)

Please enter your phone number.
Street Address (*)

Please enter your street address.
City (*)

Please enter the city you live in.
State (*)

Please enter the state you live in.
Zip Code (*)

Please enter your zip code.
How long have you been a resident of Iowa? (*)

Please enter number of years you've lived in Iowa.
Social Security Number (no dashes) (*)

Please enter social security number.
Amount from last year’s tax return (*)

Please enter family's adjusted gross income from last year's tax return.
Number of siblings still at home (*)

Please enter number of siblings still living at home.
Total of family members in college next year including applicant (*)

Please enter total of family members in college next year (including applicant).
Name and occupation of father or guardian

Father or guardian’s name and occupation.
Name and occupation of mother or guardian (*)

Mother or guardian’s name and occupation.
Are you a current PTA Member? Applicable if school has a PTSA (*)

Are you a current PTA Member?
If not PTA member please list current PTA sponsor member and school - parents can be sponsors if PTA members

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Institution you are planning to attend next year (*)

Institution you are planning to attend for the coming year.
Street address of institution (*)

Please enter address of institution
City of institution (*)

Please enter city of institution
State of institution (postal abbreviation) (*)

Please enter state of institution
Institution Zip Code (*)

Please enter the institution's zip code.
Briefly state your future educational plans and goals (*)

Please enter your future educational plans and goals.

Education Information

Name of your high school (*)

Please enter the name of your high school.
High school street address (*)

Please enter high school address.
High school city (*)

Please enter high school city.
High school state (postal abbreviation) (*)

Please enter state of high school.
High school zip code (*)

Please enter the high school's zip code.
Date of Graduation (*)

Please enter Date of Graduation.
ACT Score

Please enter ACT Score.
SAT Score

Please enter ACT Score.
Class Rank and Size (*)

Please enter Class Rank/Size.
Have you earned college credit while attending high school? If "yes", attach college transcript with application.

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Upload your college transcript if applicable

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Additional Information


PERSONAL LETTER - Please attach a personal letter giving a short biography and an explanation why you are applying for this scholarship. Include a paragraph explaining why you have selected your chosen vocation. This must be typed to be considered for scholarship.

Upload Personal Letter (*)

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ACHIEVEMENT EXAMPLE - Please attach one example of your ability in any field. i.e. an award in extracurricular activities, a project for academic classes or outside activities, a written assignment from a class (copy only as this will not be returned). This is a requirement to be considered for scholarship.

Upload example of achievement (*)

Please enter example of achievement

HIGH SCHOOL TRANSCRIPT - A copy of your high school transcript should be included with your application.

Upload High School Transcript (*)

Please Upload High School Transcript.
EXTRACURRICULAR ACTIVITIES AND HONORS (*)

Please list any honors or activities.
STUDENT and PARENTAL INVOLVEMENT IN PTA

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EMPLOYMENT INFORMATION

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LETTERS of REFERENCE - Three (3) letters of reference are required. Letters may come from, but are not limited to, teachers, principals, counselors, superintendents, community leaders, and employers.

Reference Letter Providers (*)

Enter information for reference letter providers.
Upload Reference Letter 1 (*)

Upload letter of reference
Upload Letter of Reference 2 (*)

Upload letter of reference
Upload Letter of Reference 3 (*)

Upload letter of reference
Digital Signature - Type name to verify you are the applicant. (*)

Please enter name to digitally sign the document.
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