Scholarship Application Form

Note: Responses to all questions marked with an asterisk (*) are required.

*Scholarships Applying for:

• To apply for more than one scholarship, hold the CTRL Key to Make Multiple Selections.  Please submit only one application.


• Please refer to the List of Scholarships page to view the requirements for each scholarship before applying

A. J. Woods Memorial Al's Automotive Supply Albert A. Wilson Memorial by Kaskaskia Industrial Development Corporation Ameren IP Belleville Kiwanis Belleville Mid-Town Noon Lions Club Belleville News-Democrat GED Belleville Rotary Belleville Rotary Club Tom Dickerson Transfer Bertha M. Boettcher Memorial Bob Borgstede Memorial Brenda Smith Memorial Carl A. & Lorain Ranft Memorial Carl A. Ranft Memorial Carol Lehr Memorial by SWICEE Carol Sue Betty Lehr Memorial Charles M. & Jacqueline J. Stafford Memorial Charlotte Lee (Shaulter) Cuoco Memorial Chef Ollie Sommer Children's Home & Aid Collinsville Lions Club Commercial State Bank of Waterloo Curt E. Eckert & Jann Eckert Azumi Memorial Don & Veda Rodgers Memorial Book Award Don and Harriet Bunselmeyer Don Chapman Memorial Don Libby Memorial Dorothy Leidner Dr. Michael Schneider Award Edward H. Tegtmeier Memorial Egyptian Radio Club Eilering Travel/Study Award Elsie Morton Memorial by P.E.O. Ethelyn Boyd Evelyn Lawson Reinhart, R. N., Memorial Exchange Club of Belleville Experimental Aircraft Association, Chapter 64, Inc. Fairview Heights Alderman Pat Baeske Fairview Heights Mayor Gail Mitchell First Bank - Red Bud First National Bank of Sparta First National Bank of Waterloo First State Bank of Red Bud Gabrielle Kirchoff Memorial Garner Kimbrell Gateway East Artists' Guild Visual Arts Gateway FS, Inc. George & Mae Amisch Memorial George Johnson Memorial Glenn A. Horrell Memorial Greater St. Louis Business Aviation Association H. J. Haberaecker Memorial Harrisonville Telephone Company Henry & Edith Ross Herbert D. Forsyth Memorial Herstory Award Hi-Way Motor Company Howard Dewing Memorial by the Westside Optimist Club & Mrs. Howard Dewing Illinois Association of Fire Protection Districts Illinois Community College Foundation Health Improvement Illinois Oncology, LTD Jack and Evelyn Schmitt Award Jack Schiller Memorial Jackson Richard Melinder Memorial James and LaVerne Knott Jeremy Chambers Memorial - AOJ Jeremy Chambers Memorial - FS JetCorp John & Harriet Sterling John N. Bellcoff Tamburitzans Joseph, Dorothy & Richard Lepp Memorial Josh & Kari Lane Book Award Junior Service Club of St. Clair County Kate McGarrity Memorial Kathy O'Dell - Art Korean War Veterans Association Larry & Carol Schmalenberger Law Offices of Rau and Cooper Lenora Kriege Leo & Pat Konzen Lorain Ranft Memorial Lucille W. Davis Memorial - Art Maetta & Sam Gray Memorial Maeystown Sportsmen's Club Margaret & James Graham Holland, III Memorial Marilyn Casey Martha Giordano Book Award Mary Buettner - GED Mary Cassatt - Art Mary E. McGregor Memorial by FEW Matthew Middendorf Memorial - Anatomy & Physiology Award Mel & Janet Wilmsmeyer Memorial Foundation Menard Auto Sales Metro East Herb Club Midcoast Aviation, Inc. Mildred Louise Bartle Memorial Norma Marsh Wagner North County Savings Bank Orison R. & Fern E. Seibert Pamela Burkhart Memorial By Kristi Kush, RE/MAX Preferred Pearl Johnson Memorial by AAUW PFG - Middendorf R. L. Williams Memorial Ralph & Esther Brasher Memorial Red Bud Chamber of Commerce Red Bud Industries Red Bud Lions Club Rich and Dottie Brauer Scholarship by Belleville Sister Cities Richard and Roberta May Robert E. Becker Memorial Roger & Gladys Brand Roger A. Giannini Memorial Roger's Redi-Mix/Illinois Excavators Rose Mary Wagner Memorial Rotary Club of Granite City Sally A. Followell Memorial Sam Wolf Granite City Campus Scholarship funded by SWGCC Golf Scramble Schnaare Family Scott VFW Post 4183 SEIU Local 116 Maintenance and Custodial Staff Senior Citizens Club of Belleville Sheriff Mearl J. Justus Sidney Katz Memorial Southern Illinois Crankshaft Southwestern Mathematics Faculty Sparta Class of '42 St. Clair County Bar Association St. Clair County Legal Auxiliary St. Clair County Medical Society Alliance St. Elizabeth Health Foundation State Bank of Prairie du Rocher State Bank of Waterloo STEP Project Student Nurse Association Survivors of Domestic Violence Award SWIC 60th Anniversary SWIC Art Faculty Travel/Study Award SWIC English Faculty Award SWIC First Generation College Student SWIC Foundation SWIC Horticulture SWIC Horticulture Club SWIC SWGCC English Composition Award Tapestry of Community Offerings (TOCO) TheBANK of Edwardsville - Madison County TheBANK of Edwardsville - St. Clair County Theodore F. Gundlach Thielen Family Thomas Timmer Memorial Tristan G. Pinzke Memorial U.S. Congressman Jerry and Dr. Georgia Costello Velda & Jack Taylor Weir Chevrolet-Buick-Pontiac-GMC Weir Chevrolet-Buick-Pontiac-GMC West Star Aviation Weyerhaeuser Company Foundation William A. Kamm, MD Radiology Technologist William Burns Memorial William E. & Florence Schmidt Memorial - Art William E. & Florence Schmidt Memorial - Business William Howard Davis Memorial William S. Badgley Zonta Club of Belleville

Identification Information

*Social Security Number
- -
Date of Birth (mm/dd/yyyy) 

Male    Female

*Legal Name (Last, First, Middle)
Last

First

Middle

Email

*Address

*City

*State

*Zip

County

*Home Phone

Work Phone

Disabled
Yes    No
If yes, type of disability

*Southwestern Illinois College Program of Study (Select One):
AAS Business Management AAS Marketing Management AAS Office Administration and Technology Associate in Applied Science (AAS) Associate in Arts (AA) Associate in Fine Arts (AFA) Associate in Science (AS) Certificate of Completion Certificate of Proficiency Undecided
* Program Discipline
Accounting Administration of Justice Administrative Assistant Advertising Art Agriculture Air Conditioning, Heating and Refrigeration Anthropology/Archaeology Art Automotive Collision Repair Aviation Maintenance Technology Banking and Finance Biology Bricklayer Apprentice Business Administration Carpentry Apprentice Certified Cisco Network Specialist Chemical Technology Chemistry Child Care Services Clerical Communication Electronics Communication/Theater Computer Information Systems-Microcomputers Computer Science Construction Bricklayer Construction Carpentry Construction Cement Mason Construction Electrical Wireman Construction Electrical Wireman Apprentice Construction Ironworker Construction Management Technology Construction Painting and Decorating Construction Sheetmetal Cosmetology Culinary Arts Data Processing Technology Deckhand Studies Desktop Publishing Drafting Technology Earth Science Economics Education Engineering Engineering Technology English Fire Fighter Fire Officer Fire Science Food Service (16 hrs) Foreign Language General General Horticulture Geography Health Information Technology Health/Safety Education History Horticulture Hospitality/Food Service (31 hrs) Hospitality/Food Service Mgmt. Industrial Electrician Industrial Electronics/Instrumentation Industrial Electronics/Instrumentation Adv. Industrial Machining Industrial Mechanics Industrial Metalworking Industrial Pipefitting Industrial Welder Ironworker Apprentice Journalism Legal Literature Machine/Computer Operations Major Appliance Technology Massage Therapy Mathematics Medical Medical Assistant Medical Laboratory Technology Microcomputer Electronics Microcomputers (1 semester) Microcomputers (1 year) Music Nurse Assistant Nursing Education Office Support Technology Office Technology Specialist Painting & Decorating Apprentice Paralegal Studies Paramedic Paramedic Technician Philosophy Physical Education Physical Therapist Assistant Physics/Astronomy Police Academy Political Science/Pre-Law Power Plant Technology Powerplant Welding Pre-Chiropractic Pre-Dentistry Pre-Medicine Pre-Pharmacy Pre-Veterinary Medicine Process Operations Technology Psychology Radiologic Technology Real Estate Rescue Technician Respiratory Therapy Technology Secretarial Science Sheetmetal Apprentice Sign Language Sign Language/Basic Communication Small Business Management Sociology Speech Undecided Ward Clerk Webmaster Welding Technology Welding Technology - Adv. Certificate Welding Technology - Specialized Certificate Welding Technology Certificate

Southwestern Hours Completed

Southwestern Cumulative GPA

Enrollment intended for academic year:
Full Time(12 hrs. or more) Part Time(6 hrs. or more)

Anticipated Graduation from Southwestern:
May August December    Year 2007 2008 2009 2010

Are you planning to transfer to receive Bachelor's Degree after Southwestern?
Yes No

High School Attended:

High School GPA:

Grading Scale:
4.0 5.0
Year of HS Graduation:

GED Test Composite Score:

Year of GED Completion:

Employed:
Yes No
If Yes:
Full Time Part Time

Essay Requirements:

• Paste or type text into each text area below. Please limit your total responses to an equivalent of one 8 1/2" x 11" sheet of paper.
• Misspelled words and inappropriate grammar may make application ineligible.

Need help writing your essay? Please call or visit the SWIC Success Center at numbers listed below:
Belleville Campus - 618-235-2700, ext. 5495, Room 1240 (Main Complex)
Granite City Campus - 618-235-2700, ext. 6607, Room 513
Red Bud Campus - 618-235-2700, ext. 8134, Room 131

*A) Educational and Professional Goals:

*B) Recent Honors or Awards Received and Involvement in Community Groups/Organizations:

*C) Financial Need:

By submitting this application, I certify that the information on this application is correct and complete to the best of my knowledge, and I understand that information from my academic and financial history may be released to the scholarship committees, donors, and offices at SWIC if necessary, such as Financial Aid, Business Office, etc.

I also understand that Southwestern Foundation Scholarships are awarded in accordance with the Guidelines described on the Foundation web site, and that if I am awarded one of these scholarships I must meet and maintain its eligibility requirements, as well as Southwestern Illinois College’s financial aid standards of academic progress.

Please note: You cannot apply for scholarships supported by a relative, your employer or the employer of an immediate relative.