Scholarship Application

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

First Name

Middle Name

Last Name

Phone (333) 333-3333

Street Address

City

State

Zip Code

How long have you been a resident of Iowa?

Social Security Number (no dashes)

Amount from last year’s tax return

Number of siblings still at home

Total of family members in college next year including applicant

Name and occupation of father or guardian

Name and occupation of mother or guardian

Are you a current PTA Member? Applicable if school has a PTSA

Yes No

If not PTA member please list current PTA sponsor member and school - parents can be sponsors if PTA members

Institution you are planning to attend next year

Street address of institution

City of institution

State of institution (postal abbreviation)

Institution Zip Code

Briefly state your future educational plans and goals

Education Information

Name of your high school

High school street address

High school city

High school state (postal abbreviation)

High school zip code

Date of Graduation

ACT Score

SAT Score

Class Rank and Size

Have you earned college credit while attending high school? If "yes", attach college transcript with application.

Yes No

Upload your college transcript if applicable

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

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

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

Upload High School Transcript

EXTRACURRICULAR ACTIVITIES AND HONORS

STUDENT and PARENTAL INVOLVEMENT IN PTA

EMPLOYMENT INFORMATION

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

Upload Reference Letter 1

Upload Letter of Reference 2

Upload Letter of Reference 3

Digital Signature - Type name to verify you are the applicant.

The "To-Do" List

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IOWA PTA OFFICE

319-981-5210

MAILING ADDRESS:

390 17th st se

Cedar Rapids, IA 52403