Home > Apply for your Scholarship

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Please use the form below to apply for your scholarship.

Please keep in mind that the deadline for this application is April 20.

You can download a Microsoft Word copy of the application here if you would prefer to email your submission.

Please note: You cannot save this application once you have begun. If you would like to have more time to think through and answer your questions, you can download the Microsoft Word copy of the application, and then copy & paste your answers into the boxes online. You can also email your application to us at info@zukowskifoundation.org. Also keep in mind that only complete applications will be considered – so be sure to include all documents requested!

Notes to Candidates: There are certain conditions that you must continue to meet to remain eligible for this scholarship. They are:

  • You must remain academically eligible at the school/university you are attending,
  • You must complete 24 credit hours in the prior academic year,
  • You must remain a student in good standing and have no outstanding disciplinary proceedings pending,
  • You must present proof of enrollment for each academic year.
  • You must send an unofficial transcript to the foundation at the end of each semester
  • You must contact the foundation with the above required criteria

I have read and understand the conditions of the Zukowski Family Foundation Scholarship explained in the current Notes to Candidates for Scholarships. I affirm that this application is my own work. I affirm the information contained herein is true and accurate to the best of my knowledge and belief.

By entering your name and your guardian's name in the forms below, you agree to the above terms. 

Date :
 /  / 
Signature : *
Parent / Guardian Signature : *

Personal Information

Legal Name : *
Permanent Residence : *
Home Telephone : *
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Cell Phone : *
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E-mail : *
Date of Birth : *
 /  / 
Father's Name : *
Father's Current Employer : *
Mother's Name : *
Mother's Current Employer : *
Number of children living at home (including yourself) : *
Names of siblings living at home and attending public/private school : *
Number of siblings attending college/university : *
Names of siblings attending college/university : *
GPA : *
Class Rank in School : *
Career Goal : *
College you plan to attend : *
Major : *
Number of Years of Study : *
Tuition : *
Room & Board : *
Other Expenses : *
Total : *

Activities, Awards, and Work Experience

List your high school activities (sports, clubs, committees) and include any dates or positions relevant : *
List your special interests and/or hobbies : *
List your community service activities, and the roles you held, and the dates you served : *
List any awards, scholarships, or special recognitions you have received and what year you received it : *
List any part-time jobs that you have held, the type of work you did, the dates you worked, and how many hours/week you worked : *
Are you willing and able to work part-time during college? *

Narrative Section

Describe your ideas about responsibility. *
Describe your involvement in your community. *
Describe one specific example of your leadership. *
What do you hope to do and what position do you have to have upon completing college? *
What additional information do you wish to share with the Zukowski Family Foundation? *

Please attach the following to this application:

  • Transcript including SAT/ACT scores and GPA/Class Rank
  • Resume if available
  • Recommendation from a classroom teacher.
Upload File 1 (Max File Size is 2,000 KB) :
Upload File 2 (Max File Size is 2,000 KB) :
Upload File 3(Max File Size is 2,000 KB) :

Please keep in mind that only complete applications will be considered.