Scholarship Application - CWIMA - Central Wisconsin Manufacturing Alliance

Applicant Name

First Name

Last Name

Email

Address

Street Address

Street Address Line 2

City

State / Province

Zip / Postal Code

Parent | Guardian Name(if under 18 years of age)

First Name

Last Name

Parent | Guardian Address

Same as student address

Yes

Street Address

Street Address Line 2

City

State / Province

Zip / Postal Code

Highschool you attended

Year of graduation

Are you employed?

Yes
No

Employer's Name

Employer's Phone Number

Supervisor's Name

Proposed School

Northcentral Technical College
Mid-State
Nicolet
Other

if other

Proposed Major | Area of Study:

Starting Date

Expected graduation Date

Desired Scholarship

Option 1
Option 2

I affirm that the information provided on this application and supporting material is complete, accurate, and true to the best of my knowledge. I understand that providing false information may cause me to lose consideration or having financial aid revoked.

Yes

Date

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CWIMA Scholarship Application