CSCPC Application for Higher Education Funds

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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*
Current Mailing Address*
City, State & Zip*
Social Security Number*
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*
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].
Name
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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