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Hathaway Scholarship Application


(Note: *Required) The Hathaway Scholarship Program is only available to those students who graduated in or after 2006 and must be utilized within 2 years of graduating.

Social Security:                                  or  Student ID: 

First Name:*   Middle Name:    Last Name:*                            


City:*                              State:*   Zip:* 

Phone:*   Email:* (Note: N/A for none)

I am applying for the Hathaway Scholarship beginning in the following term and year:*




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*Full Time (12+ credits per semester)  *Part Time (6-11 credits per semester)

High school graduation date:

High school name:
GED completion date:
Home school graduation date:

Are you planning to apply for the need-based financial aid portion of the Hathaway Scholarship Program? (FAFSA form required)*



Please answer all the following questions:

Yes  No

*Are you a US Citizen?

Yes  No

If a male, have you complied with the selective service requirements for registration?

Yes  No

*Are you in default on a federal Title IV education loan?

Yes  No

*Do you owe a refund on a federal Title IV student aid program?

Yes  No

*Have you been convicted of a felony in this state or another jurisdiction?

By checking this box, I verify under penalty of false swearing under Wyoming Statute 6-5-303 that the above information is correct. ** More...

Please understand the following:
"By submitting this form, I hereby consent to have my grades, transcripts or other information from my admissions or financial aid files released to authorized officials when any or all of the information is required for the grant for which I am applying or may be awarded.  I also certify that the information provided is true and correct to the best of my knowledge."


If you have any questions please feel free to contact us at:

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