Scholarship Application Form

2024 Scholarship Application
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your Hispanic/Latina Heritage:*
Do you currently live in 1 of the 8 Western New York counties? And will you live in WNY while pursuing your education?*

YesNo
What is your educational pursuit?:*
Must reside in one of the 8 counties in Western New York
What year of study are you in?*

1st Year2nd Year3rd Year4th YearGraduate
What course of study are you pursuing?*

EducationHealthcare/WellnessTrade School (Ex. Culinary, Beauty, Electrician)AthleticsSTEM FieldArtsFinanceEntrepreneurshipOther
If other selected please share with us your goals.
What cultural activities are you involved in or have attended/participated in? (The last 3 years) *
Please share it with us.
Are you a High School Graduate or have you received your GED?*
What year did you graduate or did you receive your certificate?*
How would you classify your financial need in continuing your education or pursuing your career choice?*

Low need (Do not require financial need)Minor Need (For additional expenses)Moderate Need (Face financial challenges)Significant Need (Can not pursue education without aid)
How did you hear about this scholarship opportunity?*

Professional ReferralPersonal ReferralSocial MediaEmailCommunity PostingCommunity EventOther Organization
Any additional information you would like to share about your choice?
Have you received any other financial scholarships?*

Yes.I have received oneYes. I have received two or moreNo. I have not received any financial help
REQUIRED DOCUMENTS
I. Personal Statement- Essay/Video/Audio File

Please include the following in your submisson:
1. What is your Heritage, Cultural Background? Share your family history with us.
2. What is your plan for your educational journey including course of study and why you chose it.
3. If selected explain how you would use your financial award.
Option1: A typed 350‐word essay

Option 2: A 3-Minute Video

Option 3: A 3-Minute Audio File

II. Proof of Current Education Registration

(Ex. Transcript, Payment receipt)

III. Valid ID (Student ID or NYS ID/Driver's License)

IV. Recommendations : Form Link
Two recommendations - 1 personal and 1 professional.

You are responsible for sending the link form to your recommenders and ensure they submit it by the deadline of 9/01/24.
CHECKLIST & UPLOAD
Required Documents to submit with Application (Upload below)*
Upload Your Documents*

UPLOAD DOCUMENTS HERE

Cancelof
I confirm that I have sent the recommendations form to a personal and professional reference.*

Yes, I have sent the recommendation link for 1 personal and 1 professional reference. 2 total.
I attest that the above information was provided by me and to the best of my knowledge*
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2024 Scholarship Application

REQUIRED DOCUMENTS

CHECKLIST & UPLOAD