Henri A. Termeer Student Scholarship Application

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

How did you hear about the Henri A. Termeer Student Scholarship?*

Please specify:*

Full Name of High School*

High School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

High School Graduation Date or Expected Date*

Name of Current or Intended College/University*

Address of Current or Intended College/University*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Expected College Graduation Date*

Are you planning to transfer schools for the 2022-2023 academic year?*

What is the name of the school you are planning to transfer to?

Parent/Guardian Full Name – Information for one parent/guardian is sufficient*

First Last

Parent/Guardian Phone Number*

Parent/Guardian Email*

Academic Information

APPLICANT ACADEMIC INFORMATION – HIGH SCHOOL/GED GRADUATE OR COLLEGE (Please upload as a pdf) – For High School or GED Graduate Applicants: Please submit a copy of your official high school transcript showing grades and cumulative GPA through December 2021 or high school equivalency diploma. For College Applicants: Please submit a copy of your official college transcript showing grades and cumulative GPA through December 2021. College applicants DO NOT need to submit high school transcripts as well.*

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB.

What is your intended major or course of study?*

Essay Prompt

Upload your response to the following prompt. (Please upload as a pdf) – Describe your educational and career goals and explain what or who has inspired or helped shape these goals. Excluding financial needs, what are the most significant challenges you expect to face in successfully completing college? How will you overcome these challenges? Please limit to 500 words or less.*

Accepted file types: pdf, Max. file size: 50 MB.

Financial Aid Agreement

You may be required to submit financial information (Student Aid Report from FAFSA or a copy of your/your families' Federal Income Tax Return). By checking the box below, you acknowledge that you will provide this information if requested.*

I agree to provide financial information upon request