Scholarship Application

Download Scholarship Application

Scholarship applications will be carefully reviewed. The BecomeX program tuition is based on a sliding scale, which includes a $100 non-refundable registration fee, all course materials and dinners. Scholarships do not include the $100 non-refundable registration fee. 50% of participants will receive full or partial, need-based scholarships in an effort to promote diversity and equal opportunity. Our program truly values the inclusion of all young women, and we will do our best to accommodate your needs.

Program Contribution
(dollar amount you would be able contribute towards the program):

Full tuition for this program is $950.

Required Essay

Please write a one-page statement explaining why you should be the recipient of a need-based scholarship and how this program is important for your future.

Applicant Statement of Finances

Name

Please choose: Marital Status Single Married Separated Divorced Widowed

Are you the primary wage earner in your household? Select One Yes No

Employer

Employer’s Address

Supervisor’s Name Phone

Applicant’s Income (for the past calendar year)

Applicant’s Earnings

Spouse’s Earnings

Parent’s Earnings

Other Income*

*Government aid will not be counted against you, please include this income if you receive it.

Do you receive Financial Aid from any other source or institution? Select One Yes No If Yes, where?

Are you currently paying for your education? Select One Yes No

If so, what are your estimated expenses per month?

Can anyone claim you as their dependent? Select One Yes No

If you answered yes to both of the above questions, you must also complete the Parental Statement of Finances below.

Parental Statement of Finances

Parent(s) Name(s)

Address City
State Zip Telephone

Marital Status: Marital Status Single Married Separated Divorced Widowed

Number of people in household, including applicant:

Number of people in private school, college, university including applicant:

Total actual dollars for tuition, room, board, etc. for children
attending private school, college, or university:
$

Number of children parent(s)/guardian(s) is/are supporting:

Parent/Guardian’s Occupation
Employer

Parent/Guardian’s Occupation
Employer

Total household income for the last calendar year:

Applicant’s Earnings

Parent(s) Earnings

Other Income

Total Income Amount

Please list below any unusual expenses.
This amount would include any outstanding debt such as large medical bills, child support, day care, college tuition for adult children living in the home, etc. Do NOT include normal living expenses such as food, mortgage/rent, credit cards or automobile payments.