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New Application

Contact and Personal Information

Must be unique

Family Information

This section asks you questions about your parents and your family. In order for us to understand your family situation, please select the choice below that describes who lives in the place where you live most of the time. If none of the choices describes your household, please select "Other" and explain your situation in the text box provided.

A note about Independent Students: You are considered an independent student only if you are able to answer "yes" to at least one of the questions from lines 46 to 58 on the FAFSA. You are not considered independent just because you live on your own or have parents who will not assist you with college costs.

Please answer the questions below about your parents as best you can, even if you don't live with them or are an independent student. If a parent is deceased, please write "deceased" in the box for work place.

Biological/Adoptive Parent 1

Biological/Adoptive Parent 2

Siblings & Other Adults

Please list siblings and other children or youth who live most of the time in the place where you live. Please include information about siblings who are away at college.

Additional Family Info (Optional)

College Information

The William Wiersma Scholarship is only available to students who are in a program for their first bachelor's degree (BA, BS, BFA, BSN, for example.) Students in one-year or two-year certificate or associate's degree programs do not qualify. Students who have been enrolled in or completed a certificate or associate's degree program who are now pursuing a bachelor's degree may apply. Students in five-plus year programs ending in a master's degree or beyond may apply for the first four (undergraduate) years of their programs. Students must be considered full-time students by their colleges.

Your student ID number can likely be found on your financial award letter. If you do not yet have one, please enter NA.

High School Information & Test Scores

SAT Test Scores (Highest for each section)

ACT Scores (Highest for each section)

Advanced Placement (AP) Test Scores

Financial Information & Uploads

Please complete the financial information using your 2015-2016 Student Aid Report (SAR) from the FAFSA, your financial aid award letter or the financial aid history from your school's portal, and your 2014 W-2 or IRS 1040 tax forms and your parent 2014 IRS 1040 tax forms. After clicking on a link, use the small "x" on the tab at the top of the page to close the page or select the application tab to return to your application.

Click here to see a sample SAR and directions to access your SAR.

Click here to go to the FAFSA website to retrieve your SAR. The SAR must be submitted in a PDF format.

Maximum upload size: 516MB
If you completed a FAFSA for this year, please include this. If you did not, you may ignore this question.
Maximum upload size: 516MB
If your information only appears online, you may attach screen shots of the information. If you have not received an award letter you may ignore this question.

College Financial Information

Use the Financial eligibility calculator to determine your cost of college. Please leave out commas and enter whole dollar amounts
Please enter your Expected Family Contribution (EFC) from the Student Aid Report (SAR) from your FAFSA. The EFC appears in the box in the middle of page one of the SAR. The number may be all zeroes. If it is blank, you need to make corrections to your SAR.

Financial Awards From Your School: Scholarships, Tuition Remission, Etc.

Referring to your Financial Aid Award information, please indicate the name and amounts of any scholarships, grants, awards or tuition remission that your college or university has offered you. Listed awards should include federal, state, and institutional aid. Do not include loans or work study.

Other Financial Awards

What awards or grants have you received from organizations or schools outside your college or university?

Financial Resources

We do not require you to send tax documents with your application. Please use the box below to supply any additional information regarding your financial situation that may be of help to us.


Maximum upload size: 516MB
Please tell us about an academic experience that has been important to you (e.g. a book, a class, an assignment, etc) and why (400-600 words)
Maximum upload size: 516MB
Please tell us about an extracurricular activity that has been important to you (e.g. a job, a volunteer experience, involvement in a community or church group, a single moment or experience, etc.) and why (400-600 words)
Maximum upload size: 516MB
Please tell us about your decision to attend college and how it will help you reach your goals (400-600 words)
If there is something that you feel we should know about you that you have not conveyed in your application, you may do so (this is not expected, but please fell free to use it for extenuating circumstances)


List your school year and summer jobs over the past 2 years, beginning with the most recent. Indicate how many hours you typically worked each week in the summer and school year at each job, and your dates of employment. (9/14 -5/15 e.g.)

Your Employment History

Include month and year range

Please add the names and email addresses of your intended recommenders below. They will receive an email with a link to to which they can upload necessary files (transcripts, letters of recommendation) if necessary. Note that you must complete the entire application before this email is sent. Please inform your recommenders as soon as possible so they have time to gather information and complete your recommendation before the deadline date.



I certify that all the statements made in this application form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I have also read and noted all requirements for this application and understand that an incomplete or late application will disqualify me from consideration for this award.

If awarded a scholarship, I give the William Wiersma Foundation permission to use my name in any materials, reports, press releases, website and activities associated with its scholarship program. I understand that all financial and academic information from my transcript and application is, and shall remain, confidential.

I give my consent for my financial aid counselor or director and representative of the William Wiersma Foundation to discuss my eligibility and need for scholarship assistance.

I waive my right to see all information submitted by my Guidance Counselor and Recommender(s).