Scholarship application form

Beaumont/Alameda prek program and Irvington Extended Day program

Please read thoroughly. Scholarships are intended for working parents and/or students presently earning 6+ credits. Scholarships will be available for summer care. We have many requests and we depend upon your accurate and complete description of your financial situation to help us make the best decision we can regarding the limited amount of money available for assistance.

Please be aware that scholarship recipients may be subject to fee increases just as regular paying families are.  It is up to the scholarship recipient to submit a new application by the deadline to be considered for additional scholarship assistance.

If there are changes in your income, you must notify IED/BAPP. Please be aware that you may be required upon request to provide a new application updating your records to qualify for financial assistance.  IED/BAPP may terminate your scholarship at any time if it learns that the financial information provided contains significant inaccuracies or is untruthful.  All scholarship applications are subject to inspection on a quarterly basis.  You will be asked to re-apply in the middle of the school year.  You will be given notice before the application is put in your folder, and you will be given a clear deadline.  If the application is not re-submitted by the deadline, you may lose your scholarship.

Finally, if IED/BAPP loses its funding base for the scholarships it is providing, IED/BAPP retains the right to terminate scholarships so long as it provides a two week notice to the scholarship recipients.  If IED/BAPP loses part of its funding, and is therefore able to continue funding some of the scholarships but not all, it may at its discretion terminate scholarship awards.

The application instructions you should follow depend on whether or not your family qualifies for free or reduced lunch. Please read the following instructions carefully.

If your family qualifies for free or reduced lunch, fill out the first page of the scholarship form with your name. You do not need to fill out the rest of the form. Attach a copy of your W-2 and the award letter from the free/reduced lunch program. You must also attach proof you have applied for child care assistance through the State of Oregon Department of Human Services and have been approved for or denied assistance. You do not need to be approved for DHS assistance in order to receive a scholarship from IED/BAPP.

If your family does not qualify for free or reduced lunch, fill out the scholarship form completely. Attach a copy of your of your tax return, W-2 form(s) and proof of expenses. Please tell us, as best you can, why you are requesting scholarship assistance.  We are not concerned with spelling, grammar, or writing style.  We are interested in hearing about any conditions or situations which you feel will help the scholarship committee in their decision making process.

Incomplete scholarship applications will not be reviewed.

FINANCIAL INFORMATION

(Please include totals for ALL household members)

__________________________________________________

NAME OF APPLICANT/S

Income:(ATTACH COPIES OF INCOME STATEMENTS)

 

Monthly wage, Salary, etc.:                                                    ________________

Child Support/Alimony (specific amount)                               ________________

Additional Income (Unemployment, General Asst., etc.)         ________________

TOTAL INCOME OF HOUSEHOLD:                                       ________________

TOTAL Number of people in your household ________________

Expenses:

(ATTACH PROOF OF EXPENSES)

 

Rent, Mortgage, Lodging, etc.:                                                ________________

Utilities (include Heat, Electricity, Water/Garbage):           ________________

Telephone:                                                                           ________________

Transportation (Auto, Bus-please estimate)                          ________________

Food and Incidentals (average monthly payments)                  ________________

Medical (Insurance-if any regular payments)                         ________________

Any other expenses we should know about?                           ________________

College loan:

TOTAL OF ALL MONTHLY EXPENSES ________________

TOTAL ASSETTS:

 

Personal Property:

Car(s) include Make/Model:                                                  ________________

IRA, 401K, Retirement accounts:                                          ________________

Stock Accounts, Bonds, and Investment Accounts:                 ________________

Market Rate Accounts or Certificates of Deposit accts:      ________________

Saving and Checking Accounts:                                             ________________

Real Property:                                                                      ________________

______________________________________________________________

 

STATE AND FEDERAL BENEFITS:

SOCIAL SECURITY:                                                            _______________

DISIBILITY ASSISTANCE:                                               _______________

VETRAN’S BENEFITS:                                                        _______________

STATE WELFARE ASSISTANCE:                                        _______________

AFDCS:                                                                               _______________

OTHER STATE/FEDERAL BENEFITS:                                 _______________

FREE/REDUCED LUNCH PROGRAM                                        _______________

ALL INFORMATION WILL BE KEPT CONFI