Application For Educational Grant printable pdf download

Application No._________

THE HAUSS-HELMS FOUNDATION, INC.

P. O. BOX 25

WAPAKONETA, OHIO 45895

Tel #419-738-4911

APPLICATION FOR EDUCATIONAL GRANT

______________________________________________________________________________________________________ ____

Name of Applicant (Please print)

Email Address

___________________________________________________________________________________________________________

Full Address of Applicant (No. & Street)

(City)

(State)

(Zip)

INSTRUCTIONS FOR COMPLETING APPLICATION

It is essential to the consideration of your application that all of the information required by the application be furnished. The

application consists of two parts, "INFORMATION RELATING TO APPLICANT" and "FAMILY AND FINANCIAL

INFORMATION". If any question does not apply to you, mark the space provided for the answer by inserting "NA". All of the

information requested is confidential and will be used solely to determine your eligibility for an educational grant. Of particular

importance is the "FAMILY AND FINANCIAL INFORMATION" part of the application which must be completed by you and

your parents or guardian. Much of the information needed to complete this part of your application must be taken from your

current federal income tax return, if you are required to file a federal income tax return, and your parents' current federal

income tax return, if they are required to file a federal income tax return. There are questions on the "FAMILY AND

FINANCIAL INFORMATION" part of your application that apply to you as applicant (and your spouse, if you are married)

regarding expenses, income, deductions, earnings, benefits and assets. You must answer these questions if they apply to you

or indicate that they do not apply by inserting "NA" in the space provided for the answer. If your parents are divorced or

separated, answer the questions relating to "parents" about the parent you lived with most of the last 12 months.

INDEPENDENT STUDENT: If you are an independent student your parents are not required to complete the questions

relating to "parents" on the FAMILY AND FINANCIAL INFORMATION part of the application. You are considered an

independent student if you meet one or more of the following criteria:

•

you were born before January 1, 1992.

•

you are married or separated (but not divorced) as of the date of the application.

•

at the beginning of the 2016-2017 school year, you will be enrolled in a master’s or doctoral program

(such as MA, MBA, MD, JD, PhD, EdD OR graduate certificate).

•

you are currently serving on active duty in the U.S. Armed Forces, or are a National Guard or Reserves

enlistee called into federal active duty for other than training purposes.

•

you are a veteran of the U.S. Armed Forces.

•

you have one or more children who receive more than half of their support from you between July 1,

2016 and June 30, 2017.

•

you have dependent(s) (other than children or spouse) who live with you and who receive more than

half of their support from you, now and through June 30, 2017.

•

at any time since you turned age 13, both of your parents were deceased, you were in foster care or

you were a dependent/ward of the court.

•

as determined by a court in your state of legal residence, you are now or were upon reaching the age of

majority, an emancipated minor (released from control by his or her parent or guardian).

•

as determined by a court in your state of legal residence, you are now or were upon reaching the age of

majority in legal guardianship.

•

on or after July 1, 2015, you were determined by a high school or school district homeless liaison to be

an unaccompanied youth who was homeless.

•

on or after July 1, 2015, you were determined by the director of an emergency shelter or transitional

housing program funded by the U.S. Department of Housing and Urban Development to be an

unaccompanied youth who was homeless.

•

on or after July 1, 2015, you were determined by a director of a runaway or homeless youth basic center or

(H:)2016-2017 HHApp2016-2017

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Application For Educational Grant

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