Workforce Scholarship

ASSISTANCE LEAGUE OF MONTGOMERY COUNTY
General Information
Current Date*
MM slash DD slash YYYY
Full Name*
First Middle Last
Birth Date*
MM slash DD slash YYYY
Cell Phone*
Home Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Are you a resident of Montgomery County?*
- Yes
- No
Are you a U.S. citizen?*
- Yes
- No
School Information
Have you completed high school?*
- Yes
- No
If Yes, list name of high school.
Have you received your GED/HSEP (High School Equivalency Program) Certificate?*
- Yes
- No
Name of Community College Entering/Attending*
Location of Community College*
Student ID No.*
For what certification Program of Study are you applying?*
What COURSE will you be taking?*
What is the approximate total cost of this course?*
When does this course start?*
When will this course end?*
Financial Information
Complete the Free Application for Federal Student Aid (FAFSA) Form, located at fafsa.ed.gov. Upon successful completion of the form, you will receive the Student Aid Report (SAR) that contains information about student aid for which you are eligible. Mail or hand carry a copy of your SAR to Assistance League. (See Submission Instructions on last page for address.)
Approximate Annual Gross Family Income*
Do your parents consider you a dependent for tax purposes?*
- Yes
- No
Source of Annual Gross Family Income*
Other Sources of Annual Gross Family Income*
Dependents (Persons for whom you provide at least 50% of their financial support)
You can claim Head of Household if you are unmarried, having cared for a dependent for over half a year, and paid more than half the cost of maintaining a home. Are you the Head of Household?*
- Yes
- No
Name Age Relationship to Applicant
Name Age Relationship to Applicant
Name Age Relationship to Applicant
Employment
Are you presently employed?*
- Yes
- No
If Yes, how many hours per week?
If not employed, list reasons for your unemployment.
ESSAY - In your own words: 1) Explain why you are pursuing this certification, and 2) Tell us your future plans.*
E-Signature
By submitting this application and checking the certification box below, I certify that the information included in this application is true and correct to the best of my knowledge. I authorize release of information to confirm and/or verify the contents for scholarship purposes only. In addition, I give Assistance League of Montgomery County permission to publish in print, electronic, or visual format the likeness or image of me. I waive any rights of compensation or copyright ownership thereto.
Certification:*
- I certify the information as stated above.
Submission Instructions
When you have completed this application, click the "Submit" button below. In addition, mail or hand carry to the Assistance League Thrift Shop the following documents: 1) A COMPLETE copy of your FAFSA Student Aid Report (SAR) and 2) A copy of your planned Program of Study. Mail or hand carry these documents to: Jane Atwell, Scholarship Chairman, Assistance League of Montgomery County, 126 North San Jacinto Street, Conroe, TX 77301 NOTE: You will not be considered for this scholarship until Assistance League has received the above documents.
Questions
Should you have any questions, please send an email to the Scholarship Chairman at almc.scholarship@gmail.com.
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Name	Age	Relationship to Applicant

Name	Age	Relationship to Applicant

Name	Age	Relationship to Applicant

ASSISTANCE LEAGUE OF MONTGOMERY COUNTY

General Information

School Information

Financial Information

Dependents (Persons for whom you provide at least 50% of their financial support)

Employment

E-Signature

Submission Instructions

Questions