Scholarship Application

Please note: We are accepting applications from high school juniors, graduating in Spring 2025.

The SWM Scholarship Committee shall not discriminate on the basis of race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, political affiliation, gender identification or expression, or military status in any of its activities of operations.

Personal Information

Date

(mm/dd/yyyy)

Applicant Name

First Name

Last Name

Date of Birth

(mm/dd/yyyy)

Verify Email

Gender

Male

Female

Other

Phone

Race:

African American

Hawaiian or Pacific Islander

Asian

Caucasian

Hispanic

Native American

Bi-racial

Multi-racial

Other

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

County of Legal Residence

High School Currently Attending

Month of Expected Graduation

Year of Expected Graduation

Name of College or Institution Planning to Attend

Intended Major/Course of Study

Legal Guardian Information

Name of Legal Guardian

First Name

Last Name

Relationship

Guardian's Phone

Guardian's Email

Verify Email

Legal Guardian's Total Gross Income

Note: Proof of income will be required before scholarships are awarded. Priority is given to students whose guardian earns $50k or less annually. In cases where we don’t receive enough applications from students whose guardian earns $50k or less, we will award to students from the higher income group.

Do you live with your legal guardian?

Yes

Other

If not, with whom do you live?

Relationship

Name and Phone of Friend or Relative (alternate point of contact):

My mother is absent due to:

Death

Incarceration

Other

If you selected other, please explain here:

Your age when you lost your mother:

Scholarship Essay (Please Do Not Exceed 250 Words)

In a 250 word essay, please include hardships, future plans and why you should be awarded a scholarship. Essays are reviewed by the Scholarship Selection Committee with priority given to students with the greatest need.

Please list any hobbies/interests

E-Signature

By typing your first and last name here, you agree that the above information is true to the best of your knowledge. Also by submitting this application you are agreeing to have your first name, picture, and story shared for inspirational and fundraising purposes on any platform by Students Without Mothers, Inc., if you are selected as a recipient.