2026 Scholarship App Form | Salem-Roanoke County Chamber

Please complete this application no later than Friday, April 17th, 2026, at 5:00 p.m. Incomplete applications will not be considered.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

High school from which you will graduate:

Date of graduation:

Area of technical interest and/or intended career:

Please provide the following necessary information.

School Activities

*ATTACH SEPARATE SHEET IF NECESSARY

List school activities, year participated, and position held

Community Activities/Volunteer Work

*ATTACH SEPARATE SHEET IF NECESSARY

List community activities/volunteer work, year participated, and position held

Do you feel Community Activities/Volunteer Work has assisted toward your career objective?

Work Experience – Most recent employer first

*ATTACH SEPARATE SHEET IF NECESSARY

Company

From

To

Position/Duties

could most home?

Company

From

To

Date

Time

Position/Duties

Company

From

To

Position/Duties

Essay Questions

List any special recognition or awards you have received both in and out of school:

What special interests, hobbies, and/or talents do you have that might assist us in selecting you as a scholarship recipient?

What are your career objectives?

How will your career choice impact the local community?

What are the costs associated with starting a career in the field you’ve chosen? (This could include college or trade school coursework, tools and equipment, uniforms or workwear, certifications, licensure, or other training.) Please list approximate cost of the items listed.

19. Use this space to provide any additional information regarding your financial needs which would be helpful to the committee.

Provide a minimum of two letters of recommendation:

a. One from a teacher or counselor

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

b. One from someone outside of school (not a relative)

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

The information on this application is accurate to the best of my knowledge.

Name *

First

Last

Date *

The funds available for financial aid are limited. In order to distribute the award in the most equitable
manner, the applicant’s need for financial aid must be carefully evaluated. If you are independent
(emancipated) from your parents, please give your own income. Please note that all spaces must be filled in.
If they are not applicable, then mark them as N/A. Feel free to present further details on a separate email to info@s-rcchamber.org.

Self *

First

Last

Occupation *

Gross Monthly Income *

Living in the home? *

Father *

First

Last

Occupation *

Gross Monthly Income *

Living in the home? *

Mother *

First

Last

Occupation *

Gross Monthly Income *

Living in the home? *

Guardian *

First

Last

Occupation *

Gross Monthly Income *

Living in the home? *

Total gross income as shown on most recent 1040 tax form:

Number of persons dependent upon the income listed above. Include parents, dependent children, aged relatives and other as reported on income tax return:

Please list the names and ages for the question above

Number of persons listed above who are currently receiving training beyond high school:

How are these students being financed?

Please provide extenuating circumstances not given above that further show your need for financial assistance:

Please download the COUNSELOR'S REPORT ON SCHOLARSHIP APPLICANT

This is found on the "Chamber Foundation and Scholarship" page.

I certify that this information is accurate *

Yes