Contact and Personal 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.
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)
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.
High School Information & Test Scores
Advanced Placement (AP) Test Scores
Financial Information & Uploads
If you completed a FAFSA for this year, please include this. If you did not, you may ignore this question.
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
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?
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.
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)
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)
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.)
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).