Post Secondary Scholarship Application

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– Step 1 of 4

Applicant Information

Name of Applicant *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Please upload documentation of your diagnosis *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Age *

Education Information

I am currently enrolled in: *

Please include the name of the university, college, or vocational program in which you are currently enrolled.

Please include the name of the High School you currently attend.

Please include the name of the post-secondary program for which you have been accepted.

Please include a link to the post-secondary program you attend or plan to attend. *

Please upload documentation of current enrollment in or acceptance into the post-secondary program. *

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Please include at least 2 letters of recommendation. At least one should be from a professional such as a teacher/professor, counselor, coach, therapist, etc. They should mention why you would be a good fit for the program in which you are enrolled or plan to enroll and why you should be considered for this scholarship. *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Please include a short video (No more than 2 minutes) telling about yourself, the program you plan to attend, and what you hope to accomplish. *

Drag & Drop Files, Choose Files to Upload

Agreement

Why are you interested in joining Rotary? (Select all that apply) *

I attest that all information provided in this application is true to the best of my knowledge.
I understand that the video submitted may be used for marketing purposes by Autism Support of Alabama to promote the programs of the agency and/or in fundraising efforts which support the programs and services of the organization and hereby give my permission for the material to be used for such purposes.
I understand that the scholarship funds, if awarded will be paid directly to the institution in which I am enrolled. Funds may be used for costs associated with program tuition and fees

Signature of Applicant *

Clear Signature

Print Name *

Parent/ Guardian Name *

First

Last

Parent/ Guardian Email *

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Learn More

Safety

Events / Fundraising

Ways to Give

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Community

Meet the Team

Our Mission

Applicant Information

Education Information

Agreement