Check all the scholarships for which you are applying:

Mary Lou & Arthur F. Mahone ScholarshipHerzing University ScholarshipCarthage College ScholarshipCarthage College Access Education Award

Your Information

All fields must be completed on this scholarship application form. Place N/A in the field if the question does not pertain to your application. First
Last
Middle

U.S. Citizen or Permanent Resident?
yesno Ethnicity (check all that apply):
African AmericanNative AmericanHispanic AmericanAsianCaucasianOther
Date of Birth

Gender
malefemaleothernon-binaryprefer not to say Address 1
Address 2

City
State
Zip code

Phone

Email

Father/Legal Guardian

Full Name (last, first)
Occupation
Employer
Phone
Email

Mother/Legal Guardian

Full Name (last, first)
Occupation
Employer
Phone
Email

# of Dependents in Family

# of Dependents in College/Technical School

Educational Info

High School Attended
Graduation Date

Unweighted GPA
Unweighted Class Rank
ACT/SAT

List below the colleges to which you have applied and indicate if you have been accepted (one per line).
Planned Major

Financial Info

Please provide as much detail as possible. All information is confidential.Are you seeking or have you received other financial assistance (scholarships, grants, aid programs)?
yesnoIf yes, how much will you receive each year?
Do you plan to work during the school year?
yesnoIndicate any unusual or large expenses during your high school career that you and your family have experienced. State nature and amount:
Explain why you need financial assistance to continue your education:

Achievements/Activities

List any non-school activities or interests, special recognition such as awards, honors, scholarships, leadership positions, and participation. List number of hours and/or dates and years involved.

School Activities

List school and extracurricular activities such as music, yearbook, athletics, clubs and volunteer activities. Include number of years or hours and/or dates involved and leadership positions and awards, honors or scholarships received.

Employment

List part-time and summer employment; include employer and job title.

Personal Reflection

Tell us about a time when you were faced with an obstacle and what you did to overcome it. Include any special circumstances you wish considered.

References

List three references (non-family member).Name (reference 1)
Address
Phone
Relationship

Name (reference 2)
Address
Phone
Relationship

Name (reference 3)
Address
Phone
Relationship

Essay & Additional Materials

Please attach a one page essay (Times New Roman, 12 point font, double spaced). It should be a minimum of 250 but no more than 350 words on the following: What motivates you? What are your life goals, and how will a college degree help you achieve those goals?Along with your essay, please upload a current copy of your official high school transcript and a recent photo. A photo is required. If you are selected, it will be used for all publications.Please upload all attachments separately.

Submission may take a few moments. After successful submission, you will receive a confirmation message and email to follow.

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