Hathaway Transcript Transfer Request Name* First Middle Last Date of Birth* MM slash DD slash YYYY Student ID (if known) Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone* I am applying for Hathaway to be transferred FROM EWC to the following institution: (Select one)* Casper CollegeCentral Wyoming CollegeLaramie County Community CollegeNorthwest CollegeSheridan College or Gillette CollegeUniveristy of WyomingWestern Wyoming Community College I plan on using Hathaway at the selected institution beginning* Fall 2021Spring 2021Summer 2021Fall 2022Spring 2022Summer 2022 Please note: if you are currently attending EWC, the Hathaway Coordinator MUST wait until final grades are submitted before a transfer transcript can be sent to the selected institution. Hathaway Award and Use Information You have six years to use the award once you start receiving funds (unless granted an exception for military or religious service). In addition to the six year timeline restriction, Hathaway has set guidelines for using Hathaway Awards and overall eligibility: Honors, Performance, and Opportunity Levels: Students who receive the Honors, Performance, or Opportunity levels of the Hathaway Scholarship can receive the award for the equivalent of eight full-time semesters (96 total paid credits). These students can choose to use their Hathaway for up to four full-time semesters (48 paid credits) at a community college and can then use the rest of their eligibility at the University of Wyoming OR they can choose to attend the University of Wyoming for all eight semesters of eligibility. Provisional Opportunity Level: Students receiving the Provisional Opportunity level of the Hathaway Scholarship can receive the award for the equivalent of four full-time semesters (48 paid credits) at a community college. Should students receive a certificate during those semesters, the scholarship may be extended at the community college so they can pursue an additional certificate or an Associate’s Degree. Should students receive an Associate’s Degree, they may transfer the scholarship (if they have not already been paid for 96 total credits) to use at the University of Wyoming to pursue a Bachelor’s Degree. Certification and Signature By signing and submitting this application, I certify that all information provided is complete and correct. I understand that this request is to send Hathaway information to the selected institution, and that this request does not fulfill the transcript request process to request a final, official college (academic) transcript be sent to the selected institution. I understand that it is my responsibility to contact the financial aid office at the college/university that I am/will be attending if I have questions regarding the Hathaway Scholarship Program. Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Name This field is for validation purposes and should be left unchanged. Δ