Form Center

Basic Information

Name
Email Address
Address
City
State
Zip Code
Phone Number
Birthdate
Birthdate
Last 4 of Social Security #
Who is listed as Head of Household with the Housing and Redevelopment Authorities of the County of Butler?
Are you in good standing with the Housing and Redevelopment Authorities of the County of Butler?
1. Yes
2. No
Have you ever received a Scholarship through the Housing and Redevelopment Authorities of the County of Butler?
If yes, please provide Scholarship year.
Continue

Provide a typed list of all honors or awards received and any Community or School Activities in which you have participated within the last five years.*
Upload document(s) here.
Provide work/job experience.*
Upload resume here.
Write a short biography about yourself, should you be chosen as a scholarship winner this will be included in the 2023 Scholarship Program. *
Upload your biography here.
2023 Scholarship Essay*
Using the cover sheet, upload your essay here.
Continue |Go Back

By using the electronic signature below, I agree that:
All the information that I have provided is true and factual to the best of my knowledge.
I will keep the Housing and Redevelopment Authorities of the County of Butler informed of any changes in schools or enrollment status.
I will provide or respond to the Housing and Redevelopment Authorities of the County of Butler requests for periodic updates on academic progress for the duration of receipt of scholarship funds.
I am able and willing to attend the Scholarship Luncheon on August 16, 2023.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature

Leave This Blank: