Entry Form
Resident Scholarship Program Details

Awards are $6,000 each and are issued to your educational institution before the 2019 fall academic term. A total of 20 scholarships will be awarded. Scholarships may be awarded to past winners of the Scholarship Program, and past winners may submit an application up to five (5) days prior to the start of the scholarship entry period. Prior winners who enter and fulfill all requirements shall be awarded preference over new applicants, and remaining scholarships shall be awarded to new applicants after such preference is given.

Scholarship payments are made directly to your college, university, or technical school by Housing Authority Insurance, Inc., and are deposited into an FBO (for the benefit of) account. Award proceeds are to be used for tuition, books, or school supplies.

Potential winners will be asked to provide additional information. You will become a winning recipient only after we receive that information.

The check will be sent once Housing Authority Insurance, Inc., receives the completed proof of enrollment form and W-9 form for the school for the fall 2019 academic term.

The selected candidate must expend all award proceeds during their chosen institution’s fall 2019 academic term. We reserve the right to withdraw unused award proceeds from the institution.

Questions? Email us at scholarship@housingcenter.com.

Section One

Before completing Section Two, make sure you review and sign off that you reviewed the below information. Incomplete entries will not be considered and you will not be contacted if your entry form is incomplete.

I have:
1. Read the Online Privacy Policy and agreed to its terms.
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2. Read the Official Rules and agreed to the terms. Download the official rules here. 
3. Read the frequently asked questions. Download the FAQ here.
Please indicate yes or no:*
Section Two
Download each of the forms below before moving on to Section Three.

Forms to Download:
1. 2019 Affidavit –
Download form here

*Read: This form must be filled out and signed by the applicant or the applicant’s guardian if the applicant is under the age of 18

2. Proof of Residency Form
Download form here 

3. Proof of Enrollment Form – Download form here

*Read: This form must be filled out and signed by the applicant’s school

4. W-9 Form
Download form here

*Read: This form must be filled out and signed by the applicant’s school

Please Read: For applicants who have not yet enrolled in the fall 2019  academic term, please note that you will not need to upload the Proof of Enrollment and W-9 at this time. If an applicant is selected as a potential winner, he or she will have 14 days upon receiving notice from Housing Authority Insurance, Inc., to provide the completed and signed (by the school) Proof of Enrollment and W-9 forms.

Upload Affidavit Form:*
Upload Proof of Residency Form:*
Upload Photo of Applicant (JPG or PNG format)*
Upload Proof of Enrollment Form:
Upload W-9 Form:
Note: You must be a United States citizen to be eligible for this scholarship.
Section Three 
First Name*
Last Name*
Middle Name
Street Address*
Street Address Line 2
Zip Code*
Home Phone*
Cell Phone Number*
Email Address*
School Level Entering (Fall 2019)*
Number of Years Until Graduation*
Are you a US Citizen?*
Gender (optional)
Name of sponsoring housing agency:*
Is this:*