Warth Insurance Agency
1707 Mount Pleasant Street, Suite 2
Burlington, IA 52601


Fax: 319-758-6698

Scholarship Application

To submit your application online, fill out and submit the form below.

If you prefer to submit by mail, click here to download this application, and submit it to our address listed at the bottom of this page.

Applicant Information



Scholarship recipient will be required to submit most recent transcript.

Plans After High School

Extra-Curricular Activities

Essay Question

Please provide a separate written essay answering only ONE of the following questions using no more than 1000 words:

1. You are required to spend the next year of your life in either the past or the future. What year would you travel to and why? What would you do while there?

2. Should parents/legal guardians have access to their child's social media accounts, cell phone and use GPS tracking apps? Support your position.

Please send additional requirements postmarked or emailed by MARCH 1, 2020
Warth Insurance Agency
1701 Mt Pleasant St
Burlington, IA 52601

NOTE: PLEASE MAKE SURE YOU ARE COMPLETING THE 2020 APPLICATION! If the 2019 version is pulling through, clear your cookies and try again. We will email you within 5 days of receiving your application. Please contact us if you don’t receive an email.