Student for which this form is being completed:
Student Name:
First: Middle: Last:
Parent's or Guardian's information of parent completing this application:
Relationship to Student:
Parent Email*
*This email is important as we may need to contact you.
Education: What is the level of education you completed: Select High School Only Some College Vocational Degree Technical Certificate Associate Degree Bachelor Degree Masters Degree Doctoral Degree Professional School
Comment:
In this comment box, enter any details you want to include about your education.
Employment: Describe your current employment or occupation:
Other parent information:
Name:
Relationship to student:
Education: What is the level of education completed: Select High School Only Some College Vocational Degree Technical Certificate Associate Degree Bachelor Degree Masters Degree Doctoral Degree Professional School
Employment: Describe his/her employment or occupation:
Financial Information:
1. This Year's Total Family Members:
2. Last Year's Total Income Parents:
3. Last Year's Income Earned from Work:
Student:
Father:
Mother:
4. Last Year's Untaxed income and benefits (yearly totals only):
Social Security Benefits*:
*include all federal and state benefits including disability, food stamps, WIC, or any other.
Child Support received for all children:
5. Money in cash, checking and savings accounts:
Parent:
6. Parent(s) current marital status: Select Single Married Separated Divorced Widowed
7. Number of people in student's household for Current Academic Year
8. Number of college students in parent(s)' household for Current Academic Year
If there is any financial information you would like for the Selection Committee to know in making a decision about stipend eligibility, please explain here: