Educational Grant Application

Educational Grant Application

Name: ________________________________________________________ Age: _______ Date of Birth: ________________ Address: ___________________________________________________________________________________________________ Phone: _________________________________________ E-Mail Address: _________________________________________ Social Security Number: __________ - __________ - __________

Citizenship: U.S. Born p Naturalized p Other: _______________________________________________________________ Marital status: Single p Married p Divorced p Widow p

Family status: Number in household: ______________________

Housing: Rent p Own p Living with family p How long? ______________________________________________________ Have you ever been convicted of a felony?: Yesp No p

If yes, briefly explain _____________________________________________________

Are you currently employed? Yes p No p

Name of Employer, position and length of employment: _________________________________________________________ __________________________________________________________________________________________________________

Did you graduate from high school? Yes p No p

Name and City of school attended: _______________________________________________________________________ How many college units have you completed? _________________________________________________________________ Names and dates of schools attended: _____________________________________________________________ ______________________________________________________________________________________________________ Degrees received: _______________________________________________________________________________________ Other education: ________________________________________________________________________________________ List any past grants or scholarships which you have received: ____________________________________________________ _______________________________________________________________________________________________________

Are you currently enrolled in school? Yes p No p Where? _____________________________________________________

What are your educational goals? ___________________________________________________________________________ ___________________________________________________________________________________________________________ Describe your employment goal upon graduation:________________________________________________________________ ____________________________________________________________________________________________________________ Describe your long-term career goals:____________________________________________________________________________ ____________________________________________________________________________________________________________

Are you involved in any extra-curricular activities at school and/or in the community? Yes p No p

If yes, please list: ____________________________________________________________________________________________

___________________________________________________________________________________________________________

Total Annual Household Income: From work: $________

Soc. Sec./Retirement: $________ Welfare: $________

Child Support: $________ Unemployment/Other Income: $________

Current Education Financial Needs : Tuition: $________ Books: $________

Supplies $________ Misc. $________

TOTAL: $________

TOTAL INCOME: $________ Please describe any unusual circumstances which have a bearing on your current financial situation: ____________________ _______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Please list the names and addresses of three references: 1. ____________________________________________________________________________________________________ _______________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________ _______________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________

Have you previously applied for a GoGirl! Grant? Yes p No p

Where or how did you hear about The Girlfriend Factor? ___________________________________________________________ _______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Please submit a one-page (preferably typed) autobiography with this application. Include what has motivated you to pursue your education and career goals at this stage in your life, long-term goals relating to your educational and vocational plans, plus details of any experience in your chosen field. YOUR AUTOBIOGRAPHY IS AN EXTREMELY IMPORTANT CONSIDERATION IN THE SELECTION PROCESS.

With my signature below, I hereby grant the Girlfriend Factor access to my academic records. I also attest that the information stated is accurate, complete, and correct to the best of my knowledge as of this date.

Signature: ______________________________________________________ Date: _________________________________

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