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2019 Dragon Scholarship Fund Senior Award Form
Congratulations! Thank you for taking the time to provide this important information allowing us to send your award to your college!
For email addresses; please do NOT provide a jdragonmail account since your school account will not be available after graduation.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
What is your ethnicity?
*
White/Caucasian
American Indian/Alaska Native
Black/African American
Asian
Hispanic/Latino
Native Hawaiian/Pacific Islander
Multi-Racial
Decline to answer.
What is your gender?
*
Female
Male
Student Cell Phone Number
Please enter with hyphens such as: 515-123-1234
Your answer
Your Email Address (do NOT use your .jdragonmail email)
*
Do not use your "jdragonmail" account since you will not have this email after graduation. Provide an email so we can contact you.
Your answer
Intended major in college? (undecided is acceptable)
*
Your answer
What college do you plan to attend?
Des Moines Area Community College
Drake University
Iowa State University
Kirkwood Community College
University of Iowa
University of Minnesota
University of Missouri-Columnbia
University of Northern Iowa
Other:
Clear selection
When is your start date for college?
*
MM
/
DD
/
YYYY
What is the FIRST LINE of the address for the Financial Aid Department at your college/university?
*
HELPER KEY: DMACC=Financial Aid Office, ISU or U of Iowa or UNI=Office of Student Financial Aid
Financial Aid Office, Building #1
Office of Student Financial Aid
Other:
What is the SECOND LINE of the address for the Financial Aid Department at your college/university?
*
HELPER KEY: DMACC=Ankeny Blvd, ISU=Beardshear Hall, Iowa=Calvin Hall, UNI=Gilchrist Hall
2006 S. Ankeny Blvd
0210 Beardshear Hall
208 Calvin Hall
105 Gilchrist Hall
Other:
Select the CITY of your college/university
*
Ankeny
Ames
Des Moines
Cedar Falls
Cedar Rapids
Columbia
Iowa City
Minneapolis
Other:
Select the STATE of your college/university
*
Iowa
Minnesota
Missouri
Other:
Select the ZIP code of your college/university
*
HELPER KEY: DMACC=50223, ISU=5001, U of Iowa=52242, UNI=50614
50223-8995
50011-2028
52242-1315
50614
Other:
What is the scholarship amount awarded to you by the Dragon Scholarship Fund?
*
$400
$500
$600
$1000
$1500
Other:
Mother's first name
Your answer
Mother's last name
Your answer
Mother's street address
Example: 1234 NW Dragon Road
Your answer
Mother's city, state, ZIP code
Johnston, IA 50131
Other:
Clear selection
Mother's phone number
Please enter with hyphens such as: 515-123-1234
Your answer
Mother's email address
Your answer
Father's first name
Your answer
Father's last name
Your answer
Father's street address:
Example: 1234 NW Dragon Road
Your answer
Father's city, state, ZIP code
Johnston, IA 50131
Other:
Clear selection
Father's phone number
Please enter with hyphens such as: 515-123-1234
Your answer
Father's email address
Your answer
Thank you!
A copy of your responses will be emailed to the address you provided.
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