2014 Imagine America LDRSHIP Application 
 

Sponsored by:

 
 
First Name* Last Name*  
 
 
Phone* Email*  
 
 
Street* City*  
 
 
State* Zip Code*  
 
 

 
LDRSHIP College Name* LDRSHIP College Street*  
 
 
LDRSHIP College City* LDRSHIP College State*  
 
 
LDRSHIP College Zip* LDRSHIP College Rep. Name*  
 
 
LDRSHIP College Rep. Title* LDRSHIP College Rep. Phone*  
 
 
LDRSHIP College Rep Email*    
 

 
LDRSHIP Program of Study* LDRSHIP Degree Type*  
 
 
LDRSHIP Award GPA* LDRSHIP Attendance Rate (do not enter the % sign)*  
 
 
LDRSHIP Graduation Date (xx/xx/xxxx)*    
 
LDRSHIP Military Rank* LDRSHIP Branch of Service*  
 
 
LDRSHIP Military Experience Statement (should be no less than 100 words and no more than 400 words)*  
 
LDRSHIP College Experience Statement (should be no less than 100 words and no more than 400 words)*  
 
LDRSHIP List of Military Awards/Honors *  
 
Upload Letter of Recommendation from College (max file size allowed 5MB)* Upload College Transcripts (max file size allowed 5MB)*  
 
 
I have attached my college letter of recommendation for LDRSHIP* I have attached my college transcript for LDRSHIP*  
Yes
 
Yes
 
Upload DD214 (max file size allowed 5MB)* Upload Student Picture (max file size allowed 5MB)*  
 
 
I have attached my DD214* I have attached my picture for LDRSHIP *  
Yes
 
Yes
 

I hereby grant to the Imagine America Foundation and its related and successor organizations the right to use my name and information related to the Imagine America Programs, including information relating to my educational and military experience, identifying the career college I may attend, the program in which I may enroll into, and the location of that college, in any non-commercial manner including but not limited to reports, articles, submissions to government officials, and advertisements, in print, on the Internet, and in any other media.

I, also certify that the information contained herein is a complete and truthful disclosure of my personal and educational qualifications.  I give permission to the Imagine America Foundation, its related organizations, its employees and agents, and the Scholarship Committee to take steps to verify the information, as they deem necessary. I hereby release the Imagine America Foundation, its related organizations, its employees and agents, and the Scholarship Committee from any liability in connection with its proper use of information obtained. I understand the omission of facts or falsification on this application is caused for revocation of the scholarship award.

 
 
I agree*    
Yes