ROCKFORD PROMISE SCHOLARSHIP

APPLICATION FORM FOR ROCKFORD UNIVERSITY

(Must be submitted to Rockford Promise by January 11, 2018)

I, a Rockford School District 205 student eligible for graduation in 2018, am requesting a Rockford Promise scholarship. I understand that selection preference will be given to students who reside in the Midtown or Ellis Heights neighborhoods and who qualify for a PELL and MAP grant.  (You will need to apply to Rockford University.)

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Scholarship Eligibility *
I understand that, in order to be eligible for a Rockford Promise scholarship, I must meet the following requirements (Check each requirement as it is met):
Student Name
(Have Parent / Guardian Type their Name - Only Required if Student is under 18 Years of Age)