THE F.E.E.D. SCHOLARSHIP FUND

(The Fred Eckdahl Educational Development Scholarship and David H. Stainton Trust)

P.O. BOX 1443

LOVELAND, COLORADO 80539-1443

 

Date: _______________________

Name of Applicant: _____________________________________________________

Permanent Address: _____________________________________________________

______________________________________________________________________

Mailing Address: ________________________________________________________

______________________________________________________________________

Home phone: ___________________________ Work phone: ____________________

Date of Birth: _________________________________

Social Security Number: _________________________

Who is the legal party financially responsible for you if you are under age 18; ______________________________________________________________________

     1.  Are you a US Citizen? ________ yes __________ no

    If not a US Citizen please explain your citizenship status:    __________________________________________________________________

__________________________________________________________________

  1. Do you currently attend high school, college or other formal education program? ______________ name of program ____________________________________
  2. Date and name of high school graduation/GED award if not now attending high school? __________________________________________________________
  3. Are you receiving Federal Financial Aid or other scholarships, grants, loans or work study toward your education? _________If yes please list the type of financial aid you are receiving: _________________________________________________________________
  4. Have you been awarded any of the above financial aid to assist you in your continuing education? ___________ If yes please list the amount and type of financial aid you are receiving. ________________________________________ _________________________________________________________________
  5. Do you work during the school year or summer? ________ If yes, please list places of employment, hours and location. ______________________________ _________________________________________________________________
  6. Do you have other financial income? ______________ If yes please explain: _________________________________________________________________
  7. Are other persons dependent on you for financial support? __________________ Please explain: _________________________________________________________________
  8. Are you living at home with parents or other family members? ______________ If yes, please explain: _______________________________________________
  9. If you live independently from your family please state how long: ___________
  10. What degree, certificate or special education program are you seeking? _________________________________________________________________
  11. What School are you applying for? ____________________________________
  12. What is the address of the School you are planning to attend? _________________________________________________________________
  13. What is the goal you hope to achieve in this program? _________________________________________________________________
  14. On a separate page, please discuss your education and/or career goals? Please include your personal goals as they combine with your educational goals: 
  15. Please explain what your qualifications and need(s) for scholarship support are and why you are applying for this scholarship/work study?  ____________________________________________________________________________________________________________________________________

__________________________________________________________________   __________________________________________________________________

  1. Have you applied for other scholarships/work study or financial aid? __________ If yes, please list and give status of application: _________________________________________________________________
  2. If you are awarded this scholarship how would it benefit or help you? _________________________________________________________________ _________________________________________________________________
  3. Tell us a little about yourself and your family, include experiences or achievements that have special meaning to you: __________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________   
  4. Please list community, church or other organizations, services or activities you have participated in during the past two years: __________________________________________________________________ __________________________________________________________________
  5. If you could make a difference in the world around you what would that be? ____________________________________________________________________________________________________________________________________
  6. How would you go about accomplishing that? __________________________________________________________________ __________________________________________________________________
  7. Is there a person that has had a significant influence on your life? _____________ What was that influence? _____________________________________________ __________________________________________________________________
  8. Briefly explain why you feel that you need financial help from a scholarship such as this scholarship? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
  9. Are you interested in participating in a work study program? _________________
  10. Are you interested in participating in a volunteer program/ __________________
  11. Please attach a letter of recommendation from at least one counselor or faculty member and a letter from a family member, pastor or personal acquaintance.

 

PERSONAL FINANCIAL STATEMENT

 

Gross monthly income: ___________________________

Balance in checking, savings accounts: _________________________

How many people, including yourself, are supported by this income? ______________

 

Estimated Monthly Expenses:  

  1. Home rental or mortgage payment ___________________
  2. Food and clothing _________________
  3. Transportation _________________
  4. Child care costs ________________
  5. Other, i.e. medical, insurance _______________________
  6. Unusual indebtedness __________________________ 

 

 

I affirm that all statements in this application are true to the best of my knowledge.  I have read, understood, and agree with the policies attached to this application.

 

I, ____________________________________,  authorize the release of relevant information from this application and its usage to the F.E.E.D. Scholarship Fund.

 

Signature of Applicant:

__________________________________________________________

Date ______________________

 

Signature of Parent, Teacher, Counselor or other responsible party

___________________________________________________________

Date _______________________

 

 

Note:  In order to qualify for scholarship awards, the deadline listed on the cover page must be met.  Incomplete applications will not be accepted.  All applications will be considered based on need.   

 

 

Please return this application and all supporting documentation to the:

            F.E.E.D. Scholarship Fund

            P.O. Box 1443

            Loveland, CO 80539