PASSPORT TO FREEDOM SCHOLARSHIP 2016 APPLICATION FORM

Transcription

1 PASSPORT TO FREEDOM SCHOLARSHIP 2016 APPLICATION FORM Please visit to view the scholarship application guide and for information on scholarship time-lines and deadlines. Make special note of the required documents. REQUIRED DOCUMENTS All required documents must be labeled with the applicant s full name. For additional details on each of these items, please refer to the application guide. Letter(s) of reference Transcript(s) of grades Signed and dated personal statement Proof of financial need Proof of U.S. citizenship or Residency (Acceptable forms of documentation listed in I-9 List A) Copy of government issued identification (Acceptable forms of documentation listed in I-9 List B) Note: View I-9 Lists at PERSONAL INFORMATION NAME FIRST M.I. LAST MAILING ADDRESS STREET ADDRESS 1 CITY STATE STREET ADDRESS 2 ZIP CODE COUNTRY OF RESIDENCE PHONE NUMBER CELL HOME OTHER ADDRESS (required) DATE OF BIRTH AGE DATE OF BIRTH AGE ARE YOU A US CITIZEN? IF NOT, ARE YOU A LEGAL RESIDENT? PASSPORT TO FREEDON SCHOLARSHIP 2016 APPLICATION FORM PAGE 1

2 FINANCIAL INFORMATION Use the most recent income tax information or estimated current year values. If you are a dependent, fill out this section with a parent or guardian. ARE YOU A DEPENDENT? IF YES, NAME OF PARENT(S)/GUARDIAN(S) WITH WHOM YOU RESIDE: PARENTS/GUARDIANS IF YES, DO YOU OR YOUR FAMILY HAVE SAVINGS SET ASIDE TO FINANCIALLY SUPPORT YOU WHILE YOU ATTEND SCHOOL? ARE YOU CONSIDERED THE HEAD OF YOUR HOUSEHOLD? IF NO: APPLICANTS INCOME FROM WORK (IF NOT HEAD OF HOUSEHOLD): $ APPLICANTS TOTAL CASH ASSETS (IF NOT HEAD OF HOUSEHOLD): $ IF YES: NUMBER IN HOUSEHOLD YOU ARE CURRENTLY SUPPORTING FINANCIALLY (INCLUDING APPLICANT): PLEASE DESCRIBE ANY SPECIAL CIRCUMSTANCE THAT MAY AFFECT YOU OR YOUR FAMILY S ABILITY TO PAY FOR COLLEGE (MEDICAL, DIVORCE, UNEMPLOYMENT, CHILD SUPPORT, OTHER): HEAD(S) OF HOUSEHOLD S TOTAL GROSS INCOME: $ HEAD(S) OF HOUSEHOLD S TOTAL CASH ASSETS: $ (INCLUDES CASH, CHECKING/SAVINGS ACCOUNT, STOCKS, HOME EQUITY) EDUCATION DID YOU GRADUATE HIGH-SCHOOL? IF YES: HIGH SCHOOL NAME GRADUATION DATE GPA SAT SCORE ACT SCORE IF NO: DO YOU HAVE A GED? IF YES, STATE AND DATE RECEIVED STATE RECEIVED GRADUATION DATE PASSPORT TO FREEDON SCHOLARSHIP 2016 APPLICATION FORM PAGE 2

3 WHAT TYPE OF PROGRAM ARE YOU PLANNING ON ATTENDING WITH THE HELP OF THIS SCHOLARSHIP? (ALL INSTITUTIONS MUST BE ACCREDITED BY THE US DEPARTMENT OF EDUCATION) JOB CERTIFICATION PROGRAM VOCATIONAL SCHOOL TWO YEAR COLLEGE FOUR YEAR COLLEGE OTHER (DETAILS): ARE YOU CURRENTLY ENROLLED IN YOUR CHOSEN COLLEGE OR PROGRAM? IF YES, NAME OF PROGRAM: IF YES, CURRENT STANDING GPA: IF YES, AT WHAT POINT ARE YOU IN YOUR PROGRAM? FRESHMAN SOPHOMORE JUNIOR SENIOR OTHER (DETAILS): EDUCATION INSTITUTION OR PROGRAM YOU ATTEND OR PLAN TO ATTEND IN FALL 2015: FIRST CHOICE - NAME SECOND CHOICE - NAME HAVE YOU BEEN ACCEPTED TO YOUR FIRST CHOICE? IF NO, WHEN DO YOU EXPECT TO BE NOTIFIED? (DATE) HAVE YOU BEEN ACCEPTED TO YOUR SECOND CHOICE? IF NO, WHEN DO YOU EXPECT TO BE NOTIFIED? (DATE) INTENDED MAJOR OR AREA OF STUDY: ARE YOU PURSUING AN EDUCATION OR CERTIFICATION IN THE TRAVEL, TOURISM, HOSPITALITY, OR TECHNOLOGY INDUSTRIES? WILL YOU BE ATTENDING SCHOOL FULL-TIME, OR PART-TIME AS DEFINED BY YOUR INSTITUTION? FULL PART OTHER (EXPLAIN): WHERE DO YOU PLAN TO LIVE NEXT YEAR? ON-CAMPUS OFF-CAMPUS WITH PARENTS OR RELATIVES WITH FRIENDS OTHER (EXPLAIN) COST OF ATTENDANCE AT THE SCHOOL OR PROGRAM YOU PLAN ON ATTENDING Please select the time period for your answers below: 1 SEMESTER FULL YEAR FULL PROGRAM OTHER: TUITION AND FEES $ ROOM AND BOARD $ BOOKS AND SUPPLIES $ OTHER $ PASSPORT TO FREEDON SCHOLARSHIP 2016 APPLICATION FORM PAGE 3

4 EMPLOYMENT Beginning with your present or most recent job, list your employment history. (If you need more room, please attach a page to this application.) TO WHAT USE DO YOU PUT YOUR EMPLOYMENT EARNINGS? ACTIVITIES AND ACKNOWLEDGMENTS Please list any school or community related activities or roles that you would like considered as part of your application. (If you need more room, please attach a page to this application.) PASSPORT TO FREEDON SCHOLARSHIP 2016 APPLICATION FORM PAGE 4

5 AMOUNT OF SCHOLARSHIPS YOU HAVE ALREADY RECEIVED FOR NEXT YEAR SCHOLARSHIP NAMES AND AMOUNT: REQUIRED SIGNATURES All of the information I have provided in this application is accurate and is subject to verification by the Passport to Freedom scholarship selection committee at its discretion. STUDENT SIGNATURE DATE PARENT OR GUARDIAN SIGNATURE (IF APPLICANT IS A MINOR) DATE PASSPORT TO FREEDON SCHOLARSHIP 2016 APPLICATION FORM PAGE 5