F.R.E.E. Scholarship Program Application

F.R.E.E. ("Foundation") Scholarship Program Application

We are honored to work with you and deliver the exciting next step as you explore new possibilities in your life! If accepted into the F.R.E.E. Scholarship Program, we hope you will have a profoundly impactful, educational experience. We find that the people who benefit most from the F.RE.E. Scholarship Program are those who have a level of stability in their lives and are psychologically, emotionally, and physically READY to take the next step. Please answer the questions below.

Are you a Lucas County resident? *

Yes No

If No, List the City&State Which You Reside:

Full Name: *

First Name Last Name

Address *

Street Address

Street Address Line 2

City in which you will live for the next 12 months State/Province in which you will live for the next 12 months

Postal / Zip Code

Do you have a social security card? *

Yes No

Email Information: *

Phone Number: *

Area Code Phone Number

Are you eligible to work in the United States? *

Yes No

If no, please explain why:

To be ready to take your life to the next level and be considered for the F.R.E.E. Scholarship Program, you must have achieved at least six milestones in your life (the seventh one may be accomplished while involved in the program). Please initial next to those milestones you have already accomplished. You must have:

1. Already reached your eighteenth birthday.

I attest that I have reached my eighteenth birthday. *

Initial Above

2. Already earned a high school diploma or GED.

I attest that I have earned a high school diploma or GED. *

Initial Above

3. Have not been a victim of sex and/or labor trafficking for a minimum of two years.

I attest that I have not been a victim of sex and/or labor trafficking for a minimum of two years. *

Initial Above

4. Have a safe and stable living environment. Have been living at the same address for at least one year and will continue to live at that address for at least one additional year. (A safe environment is one that is free from violence and promotes positive well-being. A stable living environment is one in which the bills are paid, basic needs are met, and there are no immediate plans to move).

I attest that I have a safe and stable living environment where I have been living for at least one year and will continue to live for at least one upcoming additional year. *

Initial Above

5. Will remain in a safe and stable living environment for the next year.

I attest that I do not plan to make any significant moves over the next year. *

Initial Above

6. Have been clean from drugs and/or alcohol abuse for the past two years and am actively practicing sobriety.

I attest that I have been clean from drugs and/or alcohol abuse for the past two years and am actively practicing sobriety. *

Initial Above

7. Have been involved in trauma-focused counseling for at least one year following the last major occurence of trauma in your life or are currently in counseling. Trauma-focused counseling means that you have met with a counselor/social worker/ therapist consistently and addressed or continue to address the trauma and triggers in your life

I attest that I have been involved in trauma-focused counseling for at least one year following the last major occurrence of trauma in my life or am currently in counseling.

Initial Above

If you have not completed trauma focused therapy, you agree to complete one year of this therapy on a weekly basis during your involvement in the F.R.E.E. Scholarship Program.

Initial Above

Terms and Agreements

I agree to the Terms and Agreements above. *

Initial Above

I hereby acknowledge and attest that I have met all six eligibility requirements and that I have or will complete the seventh requirement of one year of trauma-focused counseling. I understand that if I am found to have falsely represented my eligibility, I may be eliminated for the F.R.E.E. Scholarship Program.

Signature *

Clear

Date: *

Date

Time

: Hour Minutes AM/PM Option

Initials *

DEMOGRAPHICS

ELIGIBILITY

PLEASE READ THIS STATEMENT CAREFULLY:

Applicant’s Signature