Scholarship Application for College-Bound Regina Seniors

Personal Information

Date *

First Name *

Last Name *

Address

Apt, suite, etc.

Country

City

State

Zip code

Email *

Phone *

Current Cumulative Grade Point Average (GPA)

Community Sponsored Activities

(Scouts, 4-H, Fall Fun Volunteer, etc.)

School Sponsored Activities

(Class Officer, Athletics, Music, Drama, etc. - please indicate any varsity sports)

Church Sponsored Activities

(Altar Service, Free Lunch Volunteer, etc.)

List demonstrated leadership, scholarship and compassion qualities throughout your high school years

(if you wish to be considered for the Kathleen Dore Scholarship for Women Leaders)

State why you chose to attend a Jesuit college

(if you wish to be considered for the Brendan Fisher Memorial Scholarship)

Write an essay about overcoming a non-financial personal challenge

(if you wish to be considered for the Robert H. and Marian Gaffey Scholarship)

Please state why you feel the Scholarship Committee should award this scholarship to you. *

Please limit your response to 300 words preferred.

College, university or vocational program you will attend *

(verification of enrollment must be presented to the Foundation office if you are awarded a scholarship)

Planned Major *

Financial need is shown by qualifying for Regina’s Financial Aid through the School Tuition Organization (STO) of Southeast Iowa. Please check the box below to signify agreement of the following statement.

My family utilized Financial Aid through STO of Southeast Iowa this year and authorize Regina to acknowledge my receipt of financial aid towards tuition. If the above statement is not selected, I will not be considered for a need-based scholarship.

Regina Faculty Recommendation (if you wish to be considered for the David Braverman Scholarship)

Name of faculty who will provide letter of recommendation:

Please mail recommendation letter to Regina Foundation, 2140 Rochester Ave, Iowa City IA 52245, deliver to Regina Foundation office, or email to foundation@regina.org.

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