CSCPC Application for Higher Education Funds « CASA Support Council for Pima County, Inc.

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CSCPC Application for Higher Education Funds

CASA SUPPORT COUNCIL FOR PIMA COUNTY, INC.

PLEASE READ THE “ELIGIBILITY” AND “FUNDING GUIDELINES” PRIOR TO COMPLETING THE APPLICATION
* Click Submit below when finished with the form.

Name*

(Last, First, Middle)
Date of Birth*
MM slash DD slash YYYY
Current Mailing Address*
City, State & Zip*
Primary Phone #*
Alternate Phone #*
Email address*
Are you a current or former CASA child in the Pima County CASA Program?*
- Yes
- No
If yes, was your dependency case adjudicated in Pima County Juvenile Court?*
- Yes
- No
Have you been accepted for admission to an accredited Post-secondary institution in Arizona?*
- Yes
- No
If yes, what is the name of the institution?*
Have you applied for Federal and/or State grants (e.g. Pell)*
- Yes
- No
If yes, which grants did you apply for?*
How much money from grants will you be receiving annually?*
What is the total cost of your expenses for the academic year? (include room, board, tuition, books, materials, etc.)*
Do you plan to work during the academic year?*
- Yes
- No
If yes, what will your approximate annual income be?*
Will you be receiving income from any other source?*
- Yes
- No
If yes, how much will you be receiving?*
How much funding are you requesting from CSCPC?*
EDUCATION STATUS
High School*
Name of School City/State Did you graduate? (y/n) If No, # of years left to graduate If Yes, date of Graduation
GED*
Name of School City/State Did you graduate? (y/n) If No, # of years left to graduate If Yes, date of Graduation
Other School(s)*
Name of School City/State Did you graduate? (y/n) If No, # of years left to graduate If Yes, date of Graduation
GOALS: Please tell us about yourself. How do you plan to use your education in the future? What are your short and long-term career goals?*
PLEASE READ CAREFULLY & SIGN THAT YOU UNDERSTAND & ACCEPT THIS INFORMATION
The information I provided is true and accurate to the best of my knowledge. I understand that all information may be confirmed by the CSCPC. I understand that I must also submit the “Release of Information” form with this application.
Applicant Signature*
Date*
MM slash DD slash YYYY
Thank you for submitting your application. If you have any questions about the application or the CSCPC Higher Education Funding process, please contact the Education Committee at [email protected].
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CSCPC Application for Higher Education Funds

CASA SUPPORT COUNCIL FOR PIMA COUNTY, INC.

EDUCATION STATUS

PLEASE READ CAREFULLY & SIGN THAT YOU UNDERSTAND & ACCEPT THIS INFORMATION