Scholarship Application

Janus Insurance Agency — 2026 Scholarship Program

Back to Scholarship Info

In addition to this form, please email your transcript and letter of recommendation to jason@janusagents.com

Personal Information

Tell us about yourself

First Name *

Last Name *

Date of Birth *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Academic Information

Your school and academic details

High School *

Expected Graduation Date *

GPA *

Post-Graduation Plans *

Entering the WorkforceAttending a Community CollegeOther

Career Goals

What career path interests you?

Areas of Interest *

Insurance

Sales

Business

Other

Briefly describe your career goals and plans *

Essay

Share your story

Prompt: Describe how you became interested in insurance, sales, or business. What experiences have shaped your goals, and how would this scholarship help you take the next step in your career?

Letter of Recommendation

Provide your recommender's contact information

Please have your recommender email their letter directly to jason@janusagents.com with your name in the subject line.

Recommender's Name *

Recommender's Title / Relationship *

Recommender's Email or Phone *

Certification & Signature

Confirm and sign your application

I certify that all information provided in this application is accurate and complete to the best of my knowledge. I understand that any misrepresentation may result in disqualification. *

Type Your Full Name as Signature *

Date