2015_SouthwestScholarship - Hispanic Association of Colleges and Universities

Required fields are indicated by an *.

* First Name

* Last Name

* Gender

Male Female

* DOB

/ / (MM/DD/YYYY)

* Major(s)

* Minor(s)

* Cumulative GPA - Based on a 4.0 scale

* Telephone number

* Alternate Telephone

* Email address

* Permanent Mailing address

* City

* State

* Zip Code

* Current Mailing Address

* City

* State

* Zip Code

* College/University You Are Attending

* City

* State

* Zip code

Travel awards are limited to Southwest Airlines destinations. Please select Departing and Arriving cities below.

* Number of Southwest Airlines roundtrip tickets requested.

Departure City

Arrival City

* Student Classification

Release

My information can be used for other HACU programs

I only want to be considered for this award

* Father's Name

* Country of ancestral origin

* Mother's Name

* Country of ancestral origin

* Do you speak Spanish?

Yes No

* Conversationally?

Yes No

* Fluently?

Yes No

INSTRUCTIONS FOR ESSAY QUESTIONS

Please answer the following questions that apply to you as the student. Each question must be answered in 300-500 words. Essays will be evaluated for content and grammar. Failure to complete the questions below will render your application ineligible (Note:applications with less than 300 words will NOT be reviewed).

Required for all students. Please answer the following question:

* What are your challenges in working toward higher education? (Please be specific and explain your unique circumstances)

COLLEGE UNDERGRADUATE STUDENTS
Are you a high school graduating senior or undergraduate college student?

* If YES, answer the following question.
If NO, skip to next section.

Yes No

If selected, how do you believe that obtaining travel on Southwest Airlines would benefit you and your family? (Please be specific and explain your unique circumstances in 300-500 words)

GRADUATE STUDENTS
Are you a college graduate student working on a Masters or Ph.D?

* If YES, answer the following questions.
If NO, skip to next section.

Yes No

How would the airline ticket(s) be used to help meet your goals as a graduate student? (Please be specific and explain your unique circumstances in 300-500 words)

Please list all current AND expected financial support related to your graduate academics.*

*(i.e., graduate assistantships, fellowships, departmental stipends, travel support from graduate student associations, etc.)

PREVIOUS TRAVEL AWARD RECIPIENT
Are you a previous Southwest Airlines Program Lánzate recipient?

* If YES, answer the following question.
If NO, skip to next section.

Yes No

Please explain how the award was used and how it helped you and/or your family? (200 word minimum essay - Please be specific and explain your unique circumstances)

STUDENT CERTIFICATION

I hereby agree that Southwest Airlines and HACU shall have, without further obligation to me, the right to use my name, voice, likeness, essays, and/or photograph and biographical information for advertising and promotional purposes in conjunction with this and similar promotions without notice to me and without further compensation unless prohibited by law.

If selected, I understand that I will be required to submit an Enrollment Verification Form from the college or university I am attending.

It is understood and agreed that this is a complete RELEASE and DISCHARGE of all claims and rights of the undersigned against the aforementioned parties to be released, and that no action will be taken by or on behalf of the undersigned with respect to any such rights, it being understood that this release shall be binding upon the heirs, executors, and administrators of the undersigned.

I also give my authorization, permission and consent to HACU to contact and receive information from any institution, agency, college/university and/or persons for the following purposes:

a. to verify any of the information I have provided or may provide to HACU, and/or
b. to obtain any other information concerning my scholastic/academic status in order to assess and monitor my qualifications and/or continued eligibility for this or any other award.

The authorizations, permissions and consents I have hereby given shall remain in full force and effect unless I revoke this consent in writing by letter addressed to HACU’s Development Department in San Antonio, Texas.

I hereby verify that all of the information I have provided is complete and accurate to the best of my knowledge. I further acknowledge and agree that any incomplete or false information may result in my application not being considered or in the termination of any award which may be granted.

Final Submission Notice

Please note that once you agree to these terms and submit the application you will not be able to edit, change or update this application. Therefore, please take a moment to double check all of your personal information and make sure that there are no grammatical mistakes in the essay.

* Click here to agree to above Terms and Conditions

How did you hear about the Lanzate Premio Universitario de Southwest Airlines? (Take Off! Higher Education Award from Southwest Airlines)

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