Scholarship Application

Students applying for an academic or endowment scholarship must complete this application. The priority filing deadline for institutional aid is April 1st for the fall semester and December 1st for the spring semester. A student may not receive more than one academic or endowment scholarship. Please review the eligibilty requirements.
No applications will be accepted after August 1st for Fall or January 1st for Spring.

Submit Transcripts
Applicants must submit a GED score, high school transcript and/or college transcripts for previous college courses.

Last Name:

First Name:

Middle Name:

Maiden/Previous:

*Social Security Number:

Street Address:

City, State, ZIP code:

Kansas County:

Home Phone:

Cell Phone:

Email:

Gender: Male
Female

Married Status: Married
Single

Age:
Birthdate:

Have you applied for admissions to Allen yet?: Yes
No

ACC Student ID:
Semester /Year applying for Scholarship:
Planned attendance Center:
Field of major interest:

High School Attended:

Date of High School Graduation or GED Completion:

Prior College Hours: Yes
No

List all college(s) attended:
Employer Name:

Are you a dependent of a single parent household?: Yes
No

Do you have dependents: Yes
No

Have you been out of high school more than 5 years?: Yes
No

Are you attending college for the first time?: Yes
No

Is your parent a public school teacher in: Yes
No

Are you a member of: Allen County 4-H Club for at least three years
Woodson County 4-H Club for at least three years
First Christian Church, Iola
Stark, Savonburg, or Elsmore Church

Are you or your parent(s) employed by: Allen County Hospital
City of Iola
City of Yates Center
Chartwells/Compass Group
Community National Bank
Emprise Bank
Food Service Establishment in Iola
Gates Rubber Company
Great Southern Bank
Iola Wal-Mart
Landmark Bank
Monarch Cement Company (or grandparent)
SE-KAN Asphalt
Topeka Chapter AGA

Is your parent a member of: Burlingame Rotary Club
Elsmore Ruritan
Kansas Lion's Club
Burlington Rotary Club
Iola Rotary Club
Virginia Lodge #315

By submitting my name I am verifying that the information given is accurate and that I have read and agree to the scholarship terms and conditions listed on the Institutional Scholarships and Grants-in-Aid Information page.

Name:

If form does not submit, scroll back up and look for errors in red text.
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Last Name:
First Name:
Middle Name:
Maiden/Previous:
*Social Security Number:
Street Address:
City, State, ZIP code:
Kansas County:
Home Phone:
Cell Phone:
Email: