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NEVADA WOMEN'S FUND SCHOLARSHIP APPLICATION

MUST BE RECEIVED BY NWF OFFICE BY 4:30 PM FRIDAY, MARCH 26, 2010


Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Social Security # :
Age:
Email Address:
Nevada Resident:YesNo
If 'Yes', then how long:
If 'No', What is your Hometown:
ADDITIONAL INFORMATION:
(Please note: this information will be used for internal purposes only and will not be attached to any specific applicant in NWF reporting documents.)
Martial Status:SingleMarriedWidowedDivorced
Partners Name:
Partners Occupation:
Number of Dependents:
Ages (Seperate with Commas):
Race or Ethnic Background:
EDUCATIONAL PROGRAM FOR WHICH SCHOLARSHIP IS REQUESTED
Are you a...First time ApplicantorRenewing Applicant
Renewing applicants please indicate most recent year NWF scholarship received:
Proposed field of study:
School you will/plan to attend:
Address of School:
Will you attend: or
Date course or term is scheduled to begin (mm/dd/yyyy):
When do you expect to complete this course of study (mm/dd/yyyy):
Anticipated degree or certificate:
Presently enrolled:
Accepted for enrollment:Yes
Fall 2012 Enrollment:
If enrolled in a four-year education program, what is your status (freshman, sophomore, junior, or senior?):
Educational Background: Please list the most recent school and/or training course attended, dates, field of study and degree received or current status:
INCOME / EXPENSES
New and renewing applicants, please provide annual financial information based on the most recent calendar year, Jan. – Dec.
(Please note that the Nevada Women’s Fund may require additional financial clarification by asking for your most current federal income tax return.)
Income Source $ Amount Expenses $ Amount
Job Earnings (self) Tuition & Fees
Job Earnings (spouse) Books & Supplies
Savings Housing
Financial Aid
(grants/loans)		 Utilities
Scholarships Food
Child Support Transportation
Relatives Day Care
Other Income
(Unemployment,
social security, etc.)		 Other Expenses
Total Total
FINANCIAL NEED ASSESSMENT:
Please provide the following information in order for the allocations committee to evaluate and assess your financial status. Attach additional page(s).

(1) Please describe your housing arrangements. Please be specific.

  • Whether you are living with parents, spouse or sharing accommodations with relatives or friends.
  • Whether you responsible for some amount of housing and food, split costs or are responsible for all costs.
  • How much are your housing costs on a monthly basis?
(2) Please describe the extent to which you may be responsible for a dependent. Include custody responsibilities, shared expenses, day care, etc.

(3) Please describe your work situation and the extent to which that will or will not change based on your class load. For example, you work full–time and will continue to work full–time. Or, you work part-time and because of class requirements will work as a full-time resident / intern and will no longer have a paid job.

(4) Please indicate any unusual expenses or other pertinent information that would be helpful.



Aditional Documents:


List other sources you have applied to for educational assistance and amounts requested and received (including government assistance and Millennium Scholarship).
Scholarship Received Amount / Year Scholarship Applied For Amount
WORK EXPERIENCE
List your work experience for the last three years in chronological order.
Employer Position Dates of Employment Hours per Week (FT, PT)
PURPOSE STATEMENT (New and Renewing applicants):
Include a typed statement (150-200 words). The statement should:
  • Describe why you want to further your education and three personal attributes you think will help you as you pursue your advanced degree. Include a discussion about your long-term career and personal goals.
  • Comment on an accomplishment(s) of which you are proud and/or activities with which are involved that have been of value to you.
  • Reflect upon any challenges or life experienced you have faced and how you have responded to them.
REFERENCES: New applicants please supply NWF with three signed and dated reference evaluation letters. Letters must be submitted on organizational or institutional stationary. Reference letters can include at least one from a teacher or academic advisor and one from a work or volunteer supervisor. Please provided contact information for references.
Transcript #2 upload:
Reference letter #1 upload:
Reference letter #2 upload:
Reference letter #3 upload:
I certify that to the best of my knowledge the information contained in this application is true and correct and that the NWF has my permission to use un-attributed quotes about my experiences in marketing materials.
Signed: Date
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