JOSHUA L. ANDERSON FOUNDATION
ONLINE SCHOLARSHIP APPLICATION FORM

All fields marked with a * are required – upon application submit, an error notice will appear if information is not provided for any required fields.

SECTION I: PERSONAL INFORMATION

First Name: *
Last Name: *
Middle Name:

Address: *
City: *
State: *
Zip Code: *

Email: *
Phone: *

DOB: * (mm/dd/yyyy)

SECTION II: ACADEMIC INFORMATION

High School: *
GPA: *
Graduation Date: * (mm/dd/yyyy)

College Test Scores
ACT: Composite:
SAT (CEEB) Verbal:
SAT (CEEB) Math:
College/University you plan to attend: *
Major area of study: *

SECTION III: AWARDS, EXTRACURRICULAR ACTIVITIES
Please list all activities and achievements below, including all offices held.

Scholastic/School Awards & Achievements:

Student Body and/or Class Offices:

Athletic Participation (Awards or Recognition):

Club Activities:
Community Involvement or Service:

Employment (Summer/PT):

ESSAY
Please type an essay of 500 words or less on your high school experience, college goals, career plans and how this scholarship will help you complete college. When completed, please upload below or email to info@jlafoundation.org. Acceptable file types: .docx, .doc, .txt or .pdf.

Essay (Upload here):

SECTION IV: TO BE COMPLETED BY PARENTS

Number of children in family: *
List ages of children: *
Number of children attending college as of next Fall: *
Gross family income: *

Is the applicant currently employed?
—Please choose an option—YesNo

If yes, please enter type of employment:

If awarded a scholarship, is the applicant prepared to go to enroll in college this fall?
—Please choose an option—YesNo
Has the applicant been awarded other grants or scholarships?
—Please choose an option—YesNo

List estimated college expenses and income needed to meet these expenses:

EXPENSES
Tuition: *
Room & Board: *
Books: *
Transportation: *
Other (specify):
TOTAL: *

INCOME
Working: *
Aid from parent(s): *
Scholarships: *
Other (specify):
TOTAL: *

Parent/Guardian comments or notes regarding application:

To be completed by the parent or guardian if applicant is under 18 years of age: By typing my name here, I , the parent/guardian submits his/her approval of this application and give authorization to school(s) to release copies of school records necessary to complete this application.
Parent Signature:

Date: (mm/dd/yyyy)
If student is 18 years of age or older: By typing my name here, I authorize the school(s) to release copies of school records necessary to complete this application.
Student Signature: *

Date: * (mm/dd/yyyy)

These documents will be required upon completing the application. Can be sent through email, postal mail, or can be uploaded now. Acceptable file types: .docx, .doc .txt or .pdf.

Copy of your High School Grade Report

A recent photograph of recipient

Letter of recommendation (teacher, coach, counselor, employer)

Any additional information you feel is pertinent for your consideration as a scholarship recipient.

Upon submission you should receive a copy of your application from the JLA foundation. If you do not please, use an up-to-date browser and resubmit again.

Disclaimer: The scholarship committee shall have the right to disqualify an applicant or a recipient on the basis of material misstatement on any part of the application form.

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