HOPE Network - Membership

Office Use Only

Date Sent

Date Postmarked

Application Number

2008
Edmund Springman
Educational Daycare/Tuition Grant Program

Completed application MUST include the following and be postmarked by April 30th, 2008

(Please initial that the following items are included)

_______ Two (2) signed letters of recommendation on letterhead (5 copies of each).

_______ A copy of transcript from either high school or college/technical school or a note about when we can expect the transcript mailed to office (5 copies of each).

_______ Five copies of this appliacation.

Please complete this application in order to be considered for a grant, which can be applied towards the cost of daycare or tuition beyond high school .

Applying for:

Educational Daycare Grant
Tuition Grant

Applying for or attending a:

College/University
Technical School (1-2 year Certification/Degree)
Other

If “other,” please explain: __________________________________________________________________

_____________________________________________________________________________________

NOTE: Please type or print clearly in ink only. Write “N/A” if the question does not apply to you.

1. Student’s Name _______________________________________________________________________

2. Complete Address ____________________________________________________________________

City ________________________ State ________________________ Zip Code ________________

3. Phone Number ____________________________________ Cell Phone ____________________

4. Race/Ethnic (optional, for statistic use only) ______________________________

5. Date of Birth (optional, for statistic use only) ______________________________

If you live with your parents/guardians who support you financially, answer questions #6 – 12.
Otherwise, continue to question #13.

6. Name of high school you presently attend _____________________________________________

7. Name of parents or guardians _______________________________________________________

8. Name of company where father your is employed ____________________________________________

Type of work ________________________________________________________________

9. Name of company where your mother is employed _______________________________________

Type of work ________________________________________________________________

10. Other than yourself, how many brothers and/or sisters are included on your parents’/guardians’ income tax return:

(Please list their names and ages.)

__________________________________________________________________________

11. Names, ages, and relationship of anyone else included as dependents on parents’/guardians’ income tax returns:

__________________________________________________________________________

12. List last year's gross income (before taxes) earned by your parents. ____________________________________

This section must be completed:

13. List last year's gross income (before taxes) earned by you. ___________________________________________

14. List approximate income earned from other sources (for example: food stamps, SSI, child support, alimony, unemployment compensation, disability pay, etc.) by you:

$ ________________ From _______________________________ Per Week Per Month Per Year None

(Amount) (Source)

$ ________________ From _______________________________ Per Week Per Month Per Year None

(Use a separate sheet if you need more room.)

15. Please list current employer. If not currently employed, please list most recent employer.

Employer _____________________________________________________________________________

Dates of Employment: __________________________ to ____________________________________

Monthly Gross Income: $_________________________

16. Names of your children living with you and their dates of birth:

__________________________________________________________________________

17. Explain any unusual circumstances incurred by your family within the last 12 months. (for example: medical emergencies, care of aging parent, fire or accident, etc.) Use a separate sheet if you need more room.

_______________________________________________________________________________

18. What is the highest level of schooling you have completed? _____________________________________

Are you currently attending school? YES NO

If “yes,” what level or grade? ________________ School Name? ___________________________

If “no,” have you applied to a school? YES NO

Have you been accepted? YES NO

List the colleges/technical schools to which you have applied in order of preference:

__________________________________________________________________________

19 . How long will it take for you to complete your studies? _____________________________________

20. Do you have a certified babysitter or daycare center in mind while you attend school? YES NO

If “yes,” please explain: _____________________________________________________________

_______________________________________________________________________________

What will be the total cost per hour of this childcare while you are in school? Including all your children who require care while you are in school. _______________________________________________________

How many hours a week do you estimate you will need childcare while you attend your classes? _________

21. What other educational financial aid have you applied for?

_______________________________________________________________________________

What is the amount of any such aid you have received, are receiving, or will receive?

_______________________________________________________________________________

22. Answer the following questions in essay form:
(1) What do you want to study?
(2) Why have you made that choice?
(3) What are your goals? (Please feel free to use extra paper if you need more space.)

_______________________________________________________________________________

Applicants must submit two (2) letters of recommendation from someone who knows them personally (e.g., employer, school staff, clergy person, social worker). Letters should be on letterhead and signed. Relatives and anyone associated with HOPE Network are not permitted to write a letter of reference. The following information must be included in the letter:

(1) How long has the letter writer known you?
(2) In what capacity?
(3) How would the letter writer rate your integrity and reliability in completing your educational goal?

All letters must be on letterhead and include the name, address, and phone number of the letter writer.

All information provided will be treated confidentially and used only for consideration by the Scholarship Committee. Recipients are required to complete ten (10) hours of volunteer work for HOPE Network within a six-month period following date scholarship is awarded.

I certify that all information on this application is accurate and complete to the best of my knowledge.

____________________________________________________________________________________

Applicant’s Signature, Date

HOPE Network for Single Mothers
P.O. Box 531
Menomonee Falls, WI 53052
Phone: (262) 251-7333

Application must include two (2) letters of recommendation and copy of transcript or a note stating that transcript is being sent. Grant is for HOPE Network members only. If you are not already a member, you may enclose your membership application and $5.00 fee with this grant application.

Applicants must send FIVE (5) COPIES of application, reference letters, and transcripts (unofficial or official) to HOPE's office -- copies are for our five judges.

MUST BE POSTMARKED BY APRIL 30th, 2008.