Hathaway Scholarship Application Form - Central Wyoming College

1. CWC Student #

2. Last Name

3. First name, middle initial

4. Date of Birthday

5. Gender assigned at birth (please select)

Male Female Prefer not to say Other

6. Please select the best answer to the following statement: "I have/will graduate with a ..."

high school diploma high school equivalency certificate homeschool diploma

7. Pleae enter the name of the high school or homeschool you are attending/attended (or where you attended prior to taking the high school equivalency exam)

8. What year did you/will graduate from high school or homeschool?

9. If you earned a high school equivalency certificate, what date did your/will your high school class graduate? (Students are not eligible to begin using the Hathaway Scholarship before their natural high school graduation date).

10. Email address

11. What term would you like to begin using your Hathaway Scholarship?

Fall Spring Summer

12. What year would you like to begin using your Hathaway Scholarship?

13.Have you used Hathaway funds at any other Wyoming college(s)?

Yes No

14. If you had used your Hathaway Scholarship previously, please list what school(s) and what year.

15. Are you planning to apply for the need-based portion of the Hathaway Scholarship Program? (FAFSA required)

Yes No

16. Are you a U.S. citizen or a permanent resident alien?

Yes No

17. If you are male, have you complied with the Selective Service registration requirements?

Yes No

18. Are you in default on a federal Title IV education loan?

Yes No

19. Do you owe a refund on a federal Title IV student aid loan?

Yes No

20. Have you been convicted of a felony in this state or another jurisdication?

Yes No

21. Are you currently incarcerated?

Yes No

I understand that in order to utilize the Hathaway scholarship, I must:
1) complete all CWC admissions requirements;
2) provide CWC with my final, official high school transcript with graduation date and final, cumulative, weighted GPA and ACT/SAT scores; OR GED scores and ACT/SAT scores. (If home-schooled, a list of successfully completed classes and ACT/SAT scores;)
3) initial the Hathaway Scholarship within four (4) years of high school graduation;
4) enroll and maintain continuous enrollment every fall and spring
5) enroll and complete at least size (6) college-level credits if attending part-time or twelve (12) college-level credits if attending full-time each semester (courses numbered less than 1000 are called pre-college/developmental courses and are not counted in determining credit hour course load);
6) satisfactorily complete at least twelve (12) college-level credits if attending part-time or twenth-four (24) college-level credits if attending full-time;
7) maintain minimum cumulative Hathaway GPA required for scholarships;
8) be enrolled in a qualified program; and
9) abide by the rules governing this scholarship (scholarship eligibility information can be found at: http://hathawayscholarship.org)

Certification and Signature

By signing and submitting this application, I certify that all information provided is complete and correct. I understand that I must apply for and be admitted to CWC and that I must provide final, official high school (or equivalency) transcripts and ACT and/or WorkKeys test scores necessary to establish my eligibility for this scholarship before the first day of the term I intend to initiate my Hathaway award. I also understand that I must complete the Free Application for Federal Student Aid (FAFSA) to be considered for the Need-Based Hathaway Award. I understand that it is my responsibility to contact the financial aid office at the college/university that I am attending if I have questions regarding the Hathaway Scholarship Program.

Student Signature

Date

Locations

Information For

HATHAWAY SCHOLARSHIP

HATHAWAY APPLICATION FOR CWC STUDENTS

Ready to make it happen?

Riverton

Lander

Jackson

Dubois