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GEAR UP / Hathaway Scholarship Application

First Name:


Last Name:








Zip Code:




Social Security Number:


Email Address:


I am applying for the WWCC GEAR Up Scholarship beginning in the following term and year:



I plan to enroll:


Which type of student are you:

Month and Year of High School graduation, GED completion or Home school graduation:



High School Name:

All applicants who apply for this scholarship must also complete the FAFSA (Free Application for Federal Student Aid) and apply for need based aid. Have you completed the FAFSA?

If you have not yet completed the FAFSA, what date do you plan to complete it by?

Month: Day: Year:


Are you a US citizen?

If a male over 18 years old, have you registered with selective service?


Are you in default on a federal Title IV education loan?


Do you owe a refund on a federal Title IV student aid program?


Have you been convicted of a felony in this state or another jurisdiction?


I verify under penalty of false swearing under Wyoming Statute 6-5-303 that the above information is correct.


Attended a Summer Academy?


Completed a Campus Visit?

Please describe all of the GEAR UP events and activities that you have been involved in:

By typing my name in the box below, I do hereby consent to have my grades, transcripts or other information from my admissions or financial aid files released to authorized officials when any or all of the information is required for the grant for which I am applying or may be awarded. I certify that the information provided is true and correct to the best of my knowledge. Name:          Date:      


If you have any questions please call us at 800-226-1181 or contact us here: Contact Us.

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