Bright Scholars of Iowa Scholarship Application

Contact and Demographic Information

First Name*

Middle Name*

Last Name*

Select your gender* Male
Female

Ethnicity (optional) Asian/Pacific Islander
Hispanic
Non-Resident Alien
American Indian/Alaskan Native
Black (Non-Hispanic)
White (Non-Hispanic)

Date of Birth (MM/DD/YYYY)*

Home Address*

City*

State/Prov.*

Zip*

Email*

Phone Number*

County of Residence*

Page 2 of 6

Educational Background

High School

High School Name*

Graduation Year (YYYY)*

High School GPA*

Class Rank*

ACT Score (Composite)

College

Are you currently a college student or have you ever taken any classes for college credit?* Yes No

College GPA*

Name of College/University Attended*

Year(s) attended (YYYY-YYYY)*

Degree Earned (if any)

Page 3 of 6

Future Plans

Briefly describe your career/educational goals.*

Plan to Enroll at Southwestern*

Planned Major/Area of Study*

Page 4 of 6

Scholarship Eligibility Questions

Are you an employee or dependent of an employee of Burlington Northern Railroad?* Yes No

Name of BN Employee*

Relationship to BN Employee*

Are you a dependent or relative of a Creston Eagles member?* Yes No

Name of Eagles Member*

Relationship to Member*

Are you a dependent or relative of a Kiwanis member?* Yes No

Name of Kiwanis Member*

Relationship to Kiwanis Member*

Are you an employee or dependent of an employee at SWCC?* Yes No

Are you a veteran or an immediate relative of a veteran? (parent, grandparent, sibling, child)* Yes No

Have you or a relative/dependent served in an overseas conflict? (parent, grandparent, sibling, child)* Yes No

Name of Veteran*

Relationship to Veteran*

City where veteran resides*

Name of Conflict

Are you a participant of the TRIO Student Support Services (SSS) program?* Yes No

Are you a participant of the Educational Talent Search (ETS) program?* Yes No

List your involvement in school sponsored and community activities. (Activity / Years or Dates)

Page 5 of 6

Creative Essay

This essay will give the scholarship committee a sense of who you are as an individual. The essay may be typed in the text box below. We would encourage you to compose your essay in an external text editor like Microsoft Word, Notepad, or Text Edit to save it for future use. You can simply copy and paste the contents of your essay here when complete.

The writing assignment is as follows:

If you had the authority to change your community in a positive way, what specific changes would you make?

Essay (4000 chars left)*

Page 6 of 6

Reference Letters

To finish your application, please submit ONE recent (within last six months), signed letter of reference from ONE of the following examples: a high school faculty or staff member, college faculty or staff member, community or business leader, or an employer.

Your ONE letter of reference must be on company or school letterhead and dated within the last six months. Any submitted items that do not meet these criteria will not be accepted making your application incomplete.

E-mail items to:	maitlen@swcciowa.edu
Bring Items to:	SWCC Administration Center Creston Campus
Mail items to:	Cait Maitlen SWCC Education Foundation 1501 W. Townline St. Creston, IA 50801

By checking this box and clicking the submit button you are digitally signing this form and your computer's IP address will be submitted with your application.

Data Consent* I agree that by submitting this form/application to Southwestern Community College, I give consent to Southwestern to store and use personal and academic-related information for all recruitment and academic records-related activities. I also agree to allow Southwestern to use multiple forms of communication for the purpose of recruitment and academic-related information during my academic career. I understand that if I do not agree to this statement, this form/application cannot be submitted.

Check the Box

Global Links and Search

Contact Us

Bright Scholars of Iowa Scholarship Application