SCHOLARSHIP APPLICATION
Mail completed application to:
Scholarships for Educational Excellence Foundation
745 S. Extension
Mesa, AZ 85210
(602) 318-5689
Or copy and paste this application into an email and send to info@seefaz.org
Application School Year: ____2011/2012
____ 2012/2013
PART I: Parent/Guardian Information
LAST NAME: ________________________ FIRST NAME: _______________________
ADDRESS: ______________________________________________________________
CITY: ____________________________ STATE: ________ ZIP CODE: _____________
HM PHONE: ____________________ WK: _______________ CELL: _______________
RELATIONSHIP: _____________________ E-MAIL: ___________________________
PART II: Student Information
Please list all students applying for scholarships in your household. If more room is needed, please add an additional sheet.
1.
Last Name: ______________________________ First Name: ______________________
Date of Birth: ________________________ Grade ________________
Name of school you wish to attend: _________________________________________
Address of school: _______________________________________________________
City: ____________________ AZ Zip: ___________ Phone: __________________
Annual tuition obligation for the school year: _______________________
2.
Last Name: ______________________________ First Name: ______________________
Date of Birth: ________________________ Grade ________________
Name of school you wish to attend: _________________________________________
Address of school: _______________________________________________________
City: ____________________ AZ Zip: ___________ Phone: __________________
Annual tuition obligation for the school year: _______________________
PART III: Statement of Need
Please write a short statement of need telling why your child needs to attend the specified school. Need does not have to be financial. Include any details to support your reasons for chosing this school or special needs of your child. (Example: child needs acclerated learning, honors courses, individualized instruction, smaller class size ratios, etc.) You may attach this statement on a separate sheet if desired.
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PART IV: Financial Stament
Please note! Beginning January 1, 2011, all scholarship recipients' families will be required by the state of AZ and SEEF to submit a financial statement. The portion listed here is required to be considered for a scholarship from SEEF. Scholarships are not limited to financial need but all persons receiving funds will be required to submit this verification before funds can be released.
Total Household Gross Income. Specify if the amounts are received weekly, bi-weekly, bi-monthly, or annually. Write $0 if no income is received.
Household members names, first and last. List everyone who lives with you full time including dependent children. | Earnings from work before deductions. | Welfare, child support, alimony | Pensions, retirement, social security | All other income |
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Total annual gross income from your household before deductions: _________________
How many people live in your household? Total: _______________________________
Detail any hardships faced by your family such as reduction of income, loss of a family member, foreclosure, health issues, financial supporting of a college student, care of relatives, etc.
PART V: Conditions of Eligibility
1. I certify that all of the named students on this application are residents of Arizona and a US citizen and will be attending a K-12 grade for the Application School Year.
2. I understand that scholarship disbursements will continue only as long as my child remains enrolled in a participating school. Participants should stay current on their portion of tuition and fee payments to the school.
3. I understand that each scholarship awarded is a single-year scholarship subject to the availability of donated funds and that a new application must be submitted for scholarships in subsequent years, except that no scholarship will apply to a grade higher than 12th.
4. I agree to all the terms of this scholarship. I understand that all decisions made by the Scholarships for Educational Excellence Foundation ("SEEF") are final and I agree to release SEEF from any liability in its efforts to provide educational scholarships.
5. I understand that SEEF pays only a portion of the total tuition for each student.
6. I declare that the information on this form, to the best of my knowledge, is complete and accurate and that I agree to the Conditions of Eligibility.
Scholarships may be used only for tution expenses for children enrolled in a quaified school in K-12 grades. A donor recommendation does not guarantee that a scholarship will be awarded. All decisions to award scholarships are at the discretion of SEEF. Scholarships are awarded without discrimination based on race, color, sex, handicap, familial status, or national origin.
Notice A.R.S. 43-1603 A school tuition organization cannot award, restrict or reserve scholarships solely on the basis of donor recommendation. A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer's own dependent.
PART V: Signature: _______________________________ Date: __________________
By signing above, I certify that all information is true and agree the conditions stated.
