Casper College Form Central
:: HATHAWAY SCHOLARSHIP APPLICATION FORM ::
Name:
Phone:
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Email Address:
Social Security # or CC Student ID #:
WISER ID #:
I am requesting the Hathaway Scholarship be initiated for the following term and year:
Fall       Spring       Summer     of 20
High school graduated/will graduate from:
Date high school graduated/will graduate from:
OR GED completion date (month/year):
High school attended if GED:
OR Home school graduation date:
I plan to attend college:
Full Time (12+ credits per semester)
Part Time (6-11 credits per semester)
Are you planning to apply for the need-based portion of the Hathaway Scholarship Program?
Yes (FAFSA required if yes)
No
Have you received Hathaway funds at any other Wyoming school?
Yes         No
If yes, where?
Please answer all the following questions:
Are you a US citizen? Yes        No
Are you a male? Yes        No
If a male age 18 or older, have you complied with the selective service requirements for registration? Yes        No
Are you in default on a federal Title IV education loan? Yes        No
Do you owe a refund on a federal Title IV student aid program? Yes        No
Under penalty of false swearing, have you been convicted of a felony in this state or another jurisdiction? Yes        No
Are you incarcerated? Yes        No
By submitting this application I certify that all information provided is true and correct. I understand that I must apply for and be admitted to Casper College and that I must provide all transcripts and test scores necessary to establish my eligibility for this scholarship.


< RETURN TO PREVIOUS PAGE >