Hathaway Scholarship Program Eastern Wyoming College Name Address City
State
Phone
Zip
Social Security# or Student ID#
E-Mail I am applying for the Hathaway to be initiated for the following term and year: Fall
Spring
Summer
of 20
If you have used your Hathaway Scholarship previously, please list school(s) and year(s): College
Date Attended
College
Date Attended
High School Where You Graduated
Date(MM/YY)
OR
GED Completion Date(MM/DD/YY)
High School(s)Prior to GED
Home School Graduation Date (MM/YY) I plan to attend college: Full Time
(12+ credits per semester)
Part Time (6-11
credits per semester)
Please answer all the following questions: ____Yes ____No
Are you US citizen?
____Yes ____No
If a male, have you complied with 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
Have you been convicted of a felony in this state or another jurisdiction?
____Yes ____No
Are you incarcerated?
By signing this application I certify that all information provided is true and correct. I understand that I must apply for and be admitted to Eastern Wyoming College and that I must provide transcripts and test scores necessary to establish my eligibility for this scholarship. ___________________________________________________________________________
________________________________________________________________
Signature
Date
Hathaway can be used for the equivalent of four full time semesters at any Wyoming community college and four semesters at UW. Provisional Opportunity students must earn a certificate or degree before transferring the scholarship to UW. Students may transfer their Hathaway at any time between semesters during the eligibility window. Please notify the Financial Aid Office at both Schools to transfer the scholarship. The student’s eligibility status, including GPA, hours completed, and payment received, will be included on the Hathaway transfer transcript. Students must be admitted as a degree seeking student to receive any financial aid. If taking courses from two institutions, the student must choose which institution will fund his or her Hathaway award. Funding can only be received from one institution. A consortium agreement is required for dually enrolled students. ****************************************************Office Use Only**************************************************
Initial HS GPA________ or GED________ Initial ACT_________ or Initial WorkKeys____________ Provisional Hathaway Scholarship Level_____________________________________________________