NEWTON COUNTY SINGLE PARENT SCHOLARSHIP FUND

Transcription

1 PROGRAM INFORMATION: NEWTON COUNTY SINGLE PARENT SCHOLARSHIP FUND PURPOSE: To provide supplemental financial assistance to single parents who are pursuing a course of instruction which will improve their income earning potential. ELIGIBILITY CRITERIA: Single parents selected for financial assistance will meet the following criteria: You live in Newton County, Arkansas You meet the following definition of "single parent" (all 3 categories) 1. Marital status: You're single (never married, widowed, divorced, legally separated*), or You're married but living apart and your divorce will be final by the time the scholarship is awarded* 2. Parenting status: You're the custodial parent or guardian with physical custody (50% or more) of at least one dependent child. A dependent child is: 18 or younger, or older than 18 and still in high school, or a severely disabled adult living with and dependent on you* 3. Living status: You're the only adult in the home with the child(ren), or You live with parents or relative(s), or You live with a roommate who is not your partner (significant other) or a co-parent* You're a legal resident of the United States (or a resident with DACA status). You've earned a high school diploma or GED. You've not previously earned a Bachelor s degree. You have at least a 2.0 cumulative GPA. Your household income is typically not more than 250% of Federal Poverty Guidelines. You've completed or are in the process of completing the Free Application for Federal Student Aid (FAFSA) (not required for DACA students or those in an approved short-term training program). You're attending or planning to attend an ASPSF approved school or training program. You're pursuing a degree or certification that leads to employment at familysupporting wages. *You'll be asked to explain your circumstances and may be asked for additional documentation. Page 1 of 7

2 REQUIREMENTS New Applicants: Each applicant must submit the following by appropriate deadline: Proof of enrollment - Class schedule for upcoming term or registrar verification. If a class schedule is not available at the time of your application, you may submit verification from the registrar with your application. However, a class schedule must still be provided before your scholarship is awarded. Proof of income - Tax return (first page of most recent year). If you are exempt from filing a tax return, submit a Proof of Income statement from the Department of Human Services. Other income verification may be considered if these documents do not apply to your situation. Pell Grant (FAFSA) copy of your Student Aid Report (SAR), or letter from your school s Financial Aid Office that states your approval or denial for financial aid during the term for which this scholarship is to be used. If you did not apply for FAFSA, provide an explanation. Official transcripts from all post-secondary schools you have attended - including your most recent term. If you have no college experience, provide your high school transcript or GED certificate. You may upload unofficial transcripts to allow us to review your application. However, official transcripts must be provided before your scholarship is awarded. Official transcripts are sent directly from the Registrar's office or their designee by mail or escript, or may be delivered in a sealed envelope to the contact listed above. Proof of marital status - Provide one of the following: divorce decree, legal separation order, spouse s death certificate, or a statement that you have never been married. Three letters of recommendation- from people other than relatives who are familiar with your character and goals. Statement of goals- explaining why you chose this particular course of study and what occupation you are considering. DEADLINES: Fall Semester: July 15, September 15 Spring Semester: December 15 Summer Semester: May 15 Page 2 of 7

3 Newton County Single Parent Scholarship Fund Application 1. Name 2. Gender: Male Female Last First Middle Maiden 3. Address Street or PO Box City State Zip 4. Phone: (Home) (Cell) 5. ( ) _ 6. Social Security Number: 7. Birthdate: 8. Marital Status: Never married / single Widowed Divorced Legally separated* Married but living apart* 9. Emergency Contact: (Name) (Relationship) (Phone) 10. How long have you been a Newton County resident? Years Months 11. Including you, how many individuals are dependent on you for financial help or support? 12. List the following information: Name of Child Age Date of Birth Type of Medical Insurance 13. Race: for reporting purposes only has no effect on your eligibility for this scholarship Black Asian Hispanic Native American Caucasian Other HOUSEHOLD INFORMATION 14. Is anyone sharing your household expenses? (excluding expenses paid by government assistance) YES NO 15. Do you have any relatives living in the area? YES NO 16. What assistance do your relatives provide to you and your children (check all that apply)? Housing Financial Help Transportation Childcare Other None Page 3 of 7

4 EDUCATIONAL: 17. What college or university will you be attending? 18. Major: 19. Number of Hours Enrolled: 20. Anticipated Graduation Date: 21. Please list below the schools you have previously attended (Grade School, High School, College, Vocational, Military, etc.) School Name Date Attended FINANCIAL AID: 22. Have you applied for Federal Financial Aid? Y or N 23. Have you received Pell? Y or N Complete the following for the academic year for which you are applying: Semester: Fall 20 Spring 20 Summer 20 Pell Amount Loan Amount SEOG Amount AR State Scholarship Workstudy Miscellaneous Aid 24. For what types of costs do you anticipate using the Single Parent Scholarship? 25. Have you previously applied for a Single Parent Scholarship? Y N Page 4 of 7

5 Financial Information: 26. Please list all sources of income you are currently receiving in Column A and income you expect to receive during the next 12 months in Column B Column A - Income received LAST 12 MONTHS Column B Income expected NEXT 12 MONTHS Monthly $ Annual $ Monthly $ Annual $ Friends/Family Employment Reserve Armed Forces Unemployment Benefits Social Security Rehabilitation HUD Rental Assistance TEA Child Support Food Stamps (SNAP) VA Benefits Other Income (List Below): TOTAL INCOME Page 5 of 7

6 EXPENSES 27. What are your average out of pocket monthly expenses? (Please list dollar amount) Housing Expense Utilities (gas, water, electric, phone) Food Transportation & Car Maintenance Insurance Coverage Loan Payments Clothing Medical (checkups, dentists, etc.) Child Care Household Goods Others (Please List) Total Amount Spent per Month EMPLOYMENT INFORMATION: 28. Will you be working while you attend school? Y or N 29. If yes, how many hours each week will you work? 30. Please list your employers for the past five years beginning with your most current: Name of Employer Address Job Title Date (From To) 31. If you have not been employed outside of the home, list your major home and community activities for the past five years. Page 6 of 7

7 The information given on this form is true and correct to the best of my knowledge and belief. I understand that any material misrepresentation or deliberate omission of a fact in my application (and/or interview) may be justification for denial of or, if a recipient, termination of scholarship assistance by the Newton County Single Parent Scholarship Fund Program. I agree that NCSPSF volunteers may contact any person or agency listed to verify information. I agree that withdrawal from school within the first month or misuse of scholarship funds may subject me to repayment of total amount. Applicant s Signature Date INFORMATION RELEASE: Please check the appropriate choice. If you are selected as a recipient, may we use your picture, name, and/or a description of you for publicity and fund-raising purposes? Yes No If no, may we use a description of you anonymously (such as a mother of two enrolled in the LPN program)? Yes No Answering no to either of the above questions will not affect your chances of being awarded a scholarship. By the end of the semester, each scholarship recipient will be required to supply a thank you letter telling us how he/she used this financial assistance. APPLICATION FORM AND ALL REQUIRED DOCUMENTS ARE TO BE RETURNED TO: Newton County Single Parent Scholarship Committee Attn: Della Hand Educational Opportunity Center North Arkansas College 1515 Pioneer Drive Harrison, AR (870) Page 7 of 7