Address (Must be within 28th Legislative District)
Date of Birth
Preferred Telephone Number
First time college freshman
Returning college student (currently enrolled)
Returning graduate student (currently enrolled)
First time graduate student
Class Rank (if available)
Anticipated Graduation Date
Not Currently Enrolled Applicants
Cumulative GPA (4.0 scale)
Name(s) of Colleges/Universities where you have applied
Of these schools, where have you been accepted?
Date of College Acceptance
Where do you plan to attend?
What will your status be during the 2019-2020 academic year? (check one)
Full Time (12+ credits)
3/4 time (9-11 credits)
1/2 time (6-8 credits)
Expected Family Contribution (EFC) located on FAFSA Student Aid Report (SAR)
Are any of your immediate family members also applying for Senator Ellis' scholarship this year?
Have you received a Senatorial Scholarship from Senator Arthur Ellis in the past?
Please list the other financial aid that you expect to receive
Have you submitted your FAFSA for the 2019-2020 academic year?
***Submission of your FAFSA is required for your scholarship application to be considered. Once you submit your FAFSA, include a complete copy of your Student Aid Report to verify its completion. Please refer to:
or call 1-800-4-FED-AID for assistance.
Please upload Student Aid Report verifying submission of your FAFSA application *
Acceptable file formats are: txt, pdf, doc, docx, rtf, jpg. The SAR report is about 4 pages long. The confirmation page alone is not sufficient.
Answer each of the following in paragraph form (no more than 250 words each):
a. Why do you want to attend college?
b. What fields are you interested in and why?
c. What personal attribute will you - or do you already - bring to your college?
Upload Short Answers:
1. Unofficial Transcript
You may include a brief statement explaining your financial situation and any other special financial circumstances.
Brief resume of your relevant extracurricular and volunteer activities.
You may include 1 letter of recommendation
Check Each Box Upon Completion of the associated task
Short answer responses
Complete copy of Student Aid Report
Click below to digitally sign this form *
I verify that the information provided here is accurate and I am a resident of the 28th Legislative District. I am aware that incomplete applications and applications received after the April 1, 2019 deadline will not be considered.
Signature of Student
Signature of Parent or Guardian (if under 18)
Please enter any two digits . Example: 12
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