*Students need to be enrolled in courses for 3-4 weeks before receiving scholarship*

PERSONAL INFORMATION

Name Date of Birth:

Address Home Phone #:

Mess. Phone #:

EDUCATION INFORMATION

What school are you currently attending?

What is your major or career focus at this time?

Are you currently enrolled? HALF-TIME FULL-TIME

Are you currently on “Academic Probation”? YES NO

When do you expect to complete your training or education?

Are you currently employed and working at least part-time? YES NO

If so, please provide the following information:

Starting Date

Employer

Position

Hourly Wage

Are you currently receiving any other type of income? If yes, briefly describe: (financial aid, social security, cash aid, etc.)

REQUEST INFORMATION

Have you ever received assistance from Social Services or Project ACE? YES NO

Housing Furniture Care Package Clothes Other

Please circle or state the type of assistance you are requesting:

SCHOLARSHIP COMPUTER (LAPTOP) GRADUATION STIPEND

OTHER:

Please estimate the amount of assistance you are requesting: $

Signature: __________________________________________ Date:

ATTACHMENTS

The following paperwork must be submitted with your application:

Proof of enrollment in school/training program (Transcripts or course schedule)

Copy of High School Diploma (If requesting computer)

Transcripts/certificate for completed computer course (If requesting computer)