Applicationfor Scholarship Waiting List

  • By submitting this application, you are agreeing to be placed on a Waiting List for consideration of a SALT Center Scholarship Award for fall and/or spring semester of the academic year 2018-2019.
  • If funding is still available, Applications for the Scholarship Waiting List will be considered in the fall,
  • Priority consideration pertained to applications submitted by March 1.

Student Contact Information

First Name:Click or tap here to enter text. Last Name:Click or tap here to enter text.

UA Student ID #:Click or tap here to enter text.

Student Cell Phone #:Click or tap here to enter text.

Permanent Mailing Address:Click or tap here to enter text.

City:Click or tap here to enter text. State: Click or tap here to enter text. Zip:Click or tap here to enter text.

UA Email Address:Click or tap here to enter

Parent Name:Click or tap here to enter text.

Parent Email Address:Click or tap here to enter text.

General Information

1.Did you / will you be submitting a FAFSA application to the UA Financial Aid Office? ☐Yes ☐No

(A FAFSA application, submitted to UA Financial Aid Office, is required to be considered for a SALT Center Scholarship Award)

2.Are you a Freshman coming to college for the first time? ☐Yes

3.If you are a Transfer student, what is your status? ☐Freshman ☐Sophomore ☐Junior ☐Senior

4.If you have been enrolled at UA, what is your status? ☐Freshman ☐Sophomore ☐Junior ☐Senior

5.If you are currently enrolled in the SALT Center, who is your Learning Specialist? Click or tap here to enter text.

6.Are you a first generation college student? ☐Yes ☐No

7.Does Vocational Rehabilitation cover some/all of your college costs? ☐Yes ☐No

8.Did you receive a SALT Center Scholarship Award during the 2017-2018 academic year? ☐Yes ☐No ☐N/A

9.Did you write a Scholarship Donor Thank You note for 2017-2018? ☐Yes ☐No ☐N/A

Additional Information (Optional)

Click or tap here to enter text.

STUDENT Signature: Click or tap here to enter text. Date: Click or tap to enter a date.

Use your UA EMAIL ACCOUNT to email this completed application to

*DO NOT use GOOGLE DOCS or any other PASSWORD-PROTECTED format when returning this application