Vivian Winston Scholarship Application

Transcription

1 Vivian Winston Scholarship Application A Women Helping Women Fund Scholarship Program Academic Year West 1 st Avenue, Suite 318, Spokane, Washington (509) [email protected] whwfspokane.org Purpose of the Scholarship Eligibility and Application Checklist The Vivian Winston Scholarship was established to assist women students and allow them to improve their lives, the lives of their children and their communities while overcoming the financial challenges of the cost of both tuition and child care. Criteria for Eligibility To qualify for the Vivian Winston Scholarship, the student must meet the following criteria: Be a continuing or incoming full-time woman student at Spokane Community College, Spokane Falls Community College or Eastern Washington University. A resident of Spokane County for at least 12 months. Have dependent children requiring child care. A minimum of a 3.0 college or high school cumulative GPA. Available to attend, as a guest, the 2013 Women Helping Women Fund Luncheon on May 20, 2013 and provide short biography for the luncheon program. Checklist of required documents. (Incomplete applications and/or missing required documents will disqualify applicant from consideration for this scholarship. A fully completed application that includes narrative about academic and personal goals and future plans on how they will contribute to the overall health of the community. (Typewritten answers and statements are preferred. However, if handwritten, must be printed and legible.) Two letters of recommendation (One must be from an educational professional teacher, professor, counselor, etc.) Most current transcript Completed application and other required documents must be delivered to designated school scholarship coordinator listed below or received by mail no later than 5 p.m., March 8, (Applications submitted directly to the Women Helping Women Fund office will not be considered.) Submit completed application packets to: 1

2 Eastern Washington University Students: Carol Vines, Manager, Women s & Gender Studies Program Eastern Washington University 207 Monroe Hall, Cheney WA [email protected] Community Colleges of Spokane Students: Patci Ryan, Scholarship Coordinator Community Colleges of Spokane Foundation 501 N. Riverpoint Blvd., Spokane WA [email protected] Continue to application on next page 2

3 Student Information: Name Address Telephone Please answer the following questions (you may include attached sheet(s) of paper if necessary). 1.) Why did you choose your academic major or area of interest? 2.) What are your plans for the future? 3

4 FINANCIAL NEED 1.) Please explain why you qualify for childcare assistance; please include pertinent information that you feel is important regarding your need. 2.) Are you currently living with your child(ren) s other parent? Yes or No If NO, please explain what type of financial support you are receiving from your child(ren) s other parent? 3.) Estimate your expected monthly childcare fees: Do you receive any assistance with your monthly childcare from (circle all that apply)? STATE ECEAP ASEWU OTHER Estimate the average amount you pay out-of-pocket per month/quarter (circle one) 4

5 OBSTACLES OR HARDSHIPS 1.) What obstacles or hardships have you experienced or are you currently experiencing that have had an impact on your ability to attend college? Please include any special circumstances that may be pertinent to your application. (500 words maximum) 2.) How have you been able to overcome these obstacles? (500 words maximum) If there is anything in this application that you think would mislead the evaluators regarding your situation, please explain. 5

6 EDUCATION HISTORY High School: Name of High School: City located in: Years attended: From To Graduated: Yes No Grade Point Average: College: Name of College: City located in: Years attended: From To Graduated: Yes No Grade Point Average: College: Name of College: City located in: Years attended: From To Graduated: Yes No Grade Point Average: 6

7 I confirm that the information furnished on this form is true and correct to the best of my knowledge and is subject to verification during the scholarship selection process. I also understand that, if interviewed, a representative of Women Helping Women Fund will take my photograph and I have signed the Permission for Photography contained on page 9 of this application. Student Signature Date: 7

8 Income Verification Sheet Student Name: Student ID # : 1.) What was your annual household income for the past year? 2.) Number in the household? 3.) What is your monthly rent/mortgage? 4.) What were your sources of income for the past year? (January-December) Child Support TANF (DSHS) Unemployment Disability Retirement Social Security Benefits Other Non-taxable Income Income Earned by You (including work study) Income Earned by Your Spouse/Live-In Partner Income or Gifts from Parents or Others Alimony Other Income Do you expect next years sources of income to be similar? If NO, please note the changes. 5.) What types of Financial Aid did you receive the past year? (Please list amounts AFTER tuition was paid) Grants/Scholarships Student Loans Work Study Other Do you expect next years sources of income to be similar? If NO, please note the changes. 8

9 I confirm that the information furnished on this form is true and correct to the best of my knowledge and is subject to verification during the scholarship selection process. Student Signature Date: Spouse Signature Date: Permission for Photography For valuable consideration received, I grant to Women Helping Women Fund the absolute and irrevocable right and unrestricted permission concerning any photographs that their representative has taken or may take of me or in which I may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including promotion, editorial, advertising, marketing and trade, without restriction as to alteration; and to use my name in connection with any use if they so choose. I release and discharge Women Helping Women Fund from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Women Helping Women Fund, as well as the person(s) who took the photographs. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns. Signature Name (Printed) Address Date 9