2014 Adult Excellence Award Application

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

 
Adult Excellence Award College Name* Adult Excellence Award College Address*  
 
 
Adult Excellence Award College City* Adult Excellence Award College State*  
 
 
Adult Excellence Award College Zip* Adult Excellence College Rep Name*  
 
 
Adult Excellence College Rep Title* Adult Excellence College Rep Phone*  
 
 
Adult Excellence College Rep Email*    
 

 
Adult Excellence Program of Study* Adult Excellence Degree Type*  
 
 
Adult Excellence GPA* Adult Excellence Attendance*  
 
 
Adult Excellence Graduation Date (xx/xx/xxxx)*    
 

 
Adult Excellence Student Statement ( Why this school? Why did you choose your program of study? What do you like most about this school? more than 100 words but no more than 400 words)*  
 
Adult Excellence IAF Testimonial( How has Imagine America helped you? How will this award help you? should be no less than 100 words and no more than 400 words)*  
 
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 Adult Excellence* I have attached my college transcripts Adult Excellence*  
Yes
 
Yes
 
Upload Student Picture (max file size allowed 5MB)*    
 
I have attached my picture for Adult Excellence*    
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