SCHOLARSHIP APPLICATION FORM

Transcription

1 ` SCHOLARSHIP APPLICATION FORM The Folded Flag Foundation Inc. Note: Fill in each blank. Use NA if not applicable. Use additional sheets where necessary to give a complete response to each item. Personal Information (Required Fields marked with * ): 1. *Name (Mr., Miss, Mrs., Ms.) (Please Circle One) 2. *Address (Street): *City: *State: *Zip: 3. *Phone Number Home: Cell: 4. * 5. *Best way to contact you: 6. *Social Security Number 7. *Date of Birth: Month Day Year 8. *Marital Status: O Married O Single O Divorced O Widowed (Please Check One) Family Member who lost his or her life as a result of hostile or terrorist action, as defined by Washington Headquarters Services, Directorate for Information Operations and Reports, Department of Defense: 9. *Full Name of Family Member 10. *Date of Family Member s Death: Month Day Year 11. *Branch of Military or Government in which Family Member Served 12. *Rank or Position of Family Member 13. *Family Member s Social Security No. 14. *Relationship of Applicant to Family Member foldedflagfoundation.org 1

2 High School Students: 15. Name of High School 16. High School City and State 17. Anticipated Graduation Date: Month Year (Attach transcript of high school record) 19. SAT: Reading Math Writing ACT Composite: H.S. GPA: Technical Schools: (Applicant or current student) 20. If in technical school, name of technical school 21. Address of technical school 22. Technical school city and state 23. Give details of courses taken 24. Nature or type of training that you wish to pursue 25. Length and date of the training session for which you are applying: Length Date 26.Degree or Certificate Sought Undergraduate/Graduate Students: (Applicant or current student) 27. Campus Wide ID No. (CWID) Student ID No. 28. Undergraduates: By the beginning of the Fall semester/quarter of this year I will have attained college credits. (Attach transcript) 29. Graduate Students: School Graduation Date Degree Major GPA FOR ALL APPLICANTS: 30. List all non-credit courses you have taken 31. *Contact Information for person at school/college for submitting Scholarship funds to: (typically Financial Aid Office or Registrar s Office) Name Title Phone No. ( ) foldedflagfoundation.org 2

3 Work Experience: 32. List your prior work experience, whether part-time, vacation or other (including significant volunteer work). (Enter your most recent experience first) From - To (Mo./Yr.) Where Description of Work Hours Worked Supervisor Name Phone Number Financial Data: 33. Complete this section to show financial aid required. Enter estimated college costs and expected funds figures below. Check college aid offices or catalogs for costs. If the college choice is not definite, enter costs of your most likely choice; send revised information as soon as you know it. Comment on all unusual factors on a separate page if necessary. Annual Estimated Costs Annual Expected Fund Sources Tuition and Fees $ Books and Supplies $ Room and Board $ Personal $ Transportation $ Other Costs (Explain) $ Total Estimated Costs $ (Explain unusual costs, such as; special equipment, costly transportation etc.) *Parent Contribution $ *Student Contribution $ Status Federal Loan(s) $ Federal Grant(s) $ Frye Scholarship $ State Loan(s) $ State Grant(s) $ College: $ Other: $ Total Funds Applied For $ * Enter what you and your mother/father expect to pay toward college costs. Explain if the parent contribution is low or if there is no student contribution. Include all aid you might receive; give title, amount and status (pending or approved). foldedflagfoundation.org 3

4 34. Amount you are requesting from the Folded Flag Foundation: $ in Tuition Amount you are requesting from the Folded Flag Foundation: $ in Living Expenses Total Requested: $ 35. How much are you receiving for VA Monthly Housing Allowance and/or DEA Monthly benefit: $ 36. Do you have a source of income? If so, how much and what is the source? (job, rental income, investments, if remarried include spouses income, etc.) Income Source Monthly Amount ($) 37. What are your regular monthly expenses? (rent, utilities. car payment, groceries, etc.) Expense Monthly Amount ($) 38.Provide any additional details regarding your need for financial aid. 39. Give any additional information that you think might be useful to the evaluating committee in considering your application. (Use additional sheets if necessary) foldedflagfoundation.org 4

5 READ, SIGN AND DATE: Certification: All of the information provided by me on this form is true and complete to the best of my knowledge. If asked, I agree to give proof of the information that I have given on this form. I realize that the committee examining my application may request proof of my need for financial assistance. I also realize that if I do not give proof when asked that my application for assistance may be denied. I UNDERSTAND that selection decisions by The Folded Flag Foundation, Inc. are final and are not subject to appeal. Applicant s Signature Date: Month Day Year foldedflagfoundation.org 5

6 REQUIRED DOCUMENTS: Please be sure to provide the required documentation listed below and send in along with the completed scholarship application form. Applications cannot be processed without full required documentation. Proof of Service > Casualty Report (DD1300)* Proof of Dependency (at least one of these): > DEERS Report > Dependent Military ID > Casualty Report (DD1300) with dependent s name listed > Birth C e rtific a t e Verification of school enrollment (at least one of these): > Letter of acceptance > Fall 2015 class schedule > Current class schedule Proof of Student Identity (Please provide at least TWO of the following): > Copy of student ID > Copy of driver s license > Other government-issued photo ID Other: (Please provide the following, if applicable): > Copy of VA Monthly Housing allowance > Copy of DEA Monthly benefit > BERSA Statement > Digital photo of applicant (optional) > Digital photo of applicant with family (optional) *In addition to providing a DoD Casualty Report (DD Form 1300), applicants may also be required to provide a Line of Duty Determination for use in further determining death from hostile action. Beneficiary eligibility may be contingent upon a line of duty finding. foldedflagfoundation.org 6