2024 Connex Foundation Scholarship Application: Contact Information
First Name *
Middle Name
Last Name *
Address 1 *
Address 2
City *
State/Province *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip/Postal Code *
Phone *
Phone Type *
Home
Mobile
Other
Work
Country *
Canada
United States
Other
Email *
Connex Foundation Scholarship Application: Residency
Please note that the scholarship has citizenship status requirements. If you prefer not to state your citizenship status, you will be declined from the award pool. This information is used only for the purposes of scholarship matching and will not be shared. Evaluators will not have access to this information, nor will it be shared with anyone else.
Residency: *
U.S. Citizen
Canadian Citizen
Permanent Legal Resident (U.S.)
Permanent Legal Resident (Canada)
Other
None
Connex Foundation Scholarship Application: Current Academics
Re-Entry Students -- Adult re-entry students must meet the following requirement:
(1) Have not received any degree after high school
Current School Status
High School Graduate
GED
Some College
Current College Students: Your GPA is required. If you are awarded a scholarship, we may verify your GPA from your transcript; if we cannot verify your GPA, you may forfeit your scholarship.
Current Cumulative GPA
Current School Name
Current High School Students: Your GPA is required. If you are awarded a scholarship, we may verify your GPA from your transcript; if we cannot verify your GPA, you may forfeit your scholarship.
High School Cumulative GPA
High School Name
Adult Re-Entry Students and Not Currently Enrolled: Your GPA is NOT required but you may list your most recent GPA.
College Cumulative GPA
High School GPA
Most Recent School Name
Date When Last in School
Connex Foundation Scholarship Application: Education Plans
School, Degree, and Major
School level next semester *
Freshman (First Year)
Sophomore (Second Year)
Junior (Third Year)
Senior (Fourth Year)
Graduate (Fifth+ Year)
Length of Program *
1 Year Program
2 Year Program
3 Year Program
4 Year Program
Upcoming Attendance Status *
Part-Time
Full-Time
Degree/Certification/Licence You are Pursuing *
Anticipated Graduation Date *
If double major, 2nd intended/declared major
Intended Career *
First Choice School/College
First choice school or school attending (Please write out full name of institution) *
School Type *
Career College
Community College
Vocational-Technical College
Four-Year College
Liberal Arts
University
School City *
School State/Province *
School Country *
Second Choice School/College
Second choice school (Please write out full name of institution)
School Type
Career College
Community College
Vocational-Technical College
Four-Year College
Liberal Arts
University
School City
School State/Province
School Country
Third Choice School/College (Please write out full name of institution)
School Type
Career College
Community College
Vocational-Technical College
Four-Year College
Liberal Arts
University
School City
School State/Province
School Country
Extra-Curricular Activities
Instructions: For each activity in which you participated over the last four years, list it in only ONE category: extra-curricular activities, community service, or work experience.
For example: If you participated in a community service club at your school, list this in either community service of extracurricular activities, but not both.
Describe your most significant extra-curricular activities since January 2015 with your most recent listed first. If you're still participating in this activity, please estimate an end date.
If you had limited availability for activities:
If you were unable to participate in activities, explain the reason(s) and how you otherwise spend your time.
EXTRA CURRICULAR ACTIVITY 1:
Club/Organization:
Start Date:
End Date:
EXTRA CURRICULAR ACTIVITY 2:
Club/Organization
Start Date:
End Date:
WORK EXPERIENCE 1:
Employer:
Job Title & Responsibilities (200 character limit):
Start Date:
End Date:
WORK EXPERIENCE 2:
Employer:
Job Title & Responsibilities (200 character limit):
Start Date:
End Date:
COMMUNITY SERVICE 1:
Organization:
Start Date:
End Date:
COMMUNITY SERVICE 2:
Organization:
Start Date:
End Date:
Awards & Honors
Instructions: List your most significant awards and honors since 2015 here, with your most recent listed first.
Examples include: prize for best writing or artwork; scholar/athlete of the year; award for perfect attendance, etc.
AWARD/HONOR 1:
Award or Honor:
Award or Honor Date:
AWARD/HONOR 2:
Award or Honor:
Award or Honor Date:
Video Submission Questionnaire
Instructions: Create a submission video answering 6 of the 10 questions below.
Steps to create a YouTube video submission (4-minute video limit): (1) Create your video on your phone, (2) Sign into YouTube, (3) From the left menu select videos, (4) Hover over the video you would like to upload, (5) Click the down arrow under "Visibility" and choose Public.
VIDEO SUBMISSION QUESTIONS:
1. Why do you believe you deserve this scholarship?
2. How will this scholarship impact your life?
3. Who is your role model and why?
4. Where do you see yourself in the next 5 years?
5. What subject is your favorite in school and why?
6. What is a meaningful experience or class you've had in school and why?
7. What role do you believe technology will play in advancing the retail industry?
8. What has driven you to follow this education path?
9. Provide an example of a time you overcame adversity.
10. Any additional thoughts or comments concerning the facilities management/trade industry you would like to share?
Your answers should highlight your unique experiences, strengths, potential, goals, and aspirations. Your goal should be to provide a strong sense of who you are, what you want to do, and who you want to be.
Please include your video link here or email it to bcowart@connexfm.com to complete your application submission.
Confidentiality Agreement
The information provided in your application will be solely used for determining a scholarship award recipient. By signing your name you are in agreement to submitting your information for consideration and you declare everything on this application is correct and accurate to the best of your knowledge.
Applicant Signature: *
