Charles M. Stewart Scholarship Application Section A: Personal InformationName(Required) First Last Age(Required) Home Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Social Security Number(Required) Phone(Required)Email(Required) Date of Birth(Required) MM slash DD slash YYYY Name of Parent Employed by Med Center Health(Required) Med Center Health Location/Department(Required) Years of Service(Required) Section B: High SchoolHigh School Name and Location(Required)High School Graduation (month/year)(Required) Section C: CollegeWill you be a full-time student at WKU?Full-Time Fall Semester 2023 Yes No Full-Time Spring Semester 2024 Yes No Academic Major(Required) Anticipated Graduation Date(Required) Have you or will you apply for financial aid? Yes No Are you a recipient of any other scholarships/grants? Yes No Please list scholarships/grants you have received(Include KEES funding or estimated amount. List each scholarship/grant separately. Do not summarize or abbreviate.)Section D: ActivitiesMembership in School Activities (High School or College)Please indicate years of membership and leadership positions.Membership in Non-School Activities(Community, church, civic, employment, etc.)Honors and AwardsSection E: Supporting DocumentationPlease upload the following documents: One-page essay explaining your financial need and why you should be awarded this scholarship. Official copy of your high school or college transcripts, including your cumulative grade point average. Please make sure ACT scores are included on the transcript. Three letters of reference (i.e., Principal, Counselor, Teacher or Employer). Please be sure to have your references include their phone number on the letter. Upload Supporting Documentation(Required) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 100 MB. Applications submitted without the required documentation will not be considered.Student Signature(Required) Reset signature Signature locked. Reset to sign again PhoneThis field is for validation purposes and should be left unchanged.
