Illinois Scholar Award Application Form
* Denotes a required field

(ex. 01/01/1996)

(123-456-7890, include area code)

   
   
(i.e., accepted, waiting to hear...)

(GPA on a scale of...ex. 3.2 on 4.0 scale)

   
   
   
   
(position)




   
   

(if taken more than once, indicate best score)

  mm/dd/yy
(123-456-7890, include area code)


VERIFICATION

Electronic signature of applicant for the Illinois Scholar Award.
Please initial in the box above. By initialing, you signify that the information provided is true and complete to the best of your knowledge.