Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Female
Male
Non-binary
Other
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
How did you hear about Inspired Scholars?
Were you in a foster care or guardianship placement after the age of 13?
*
Yes
No
Not Sure
Were you reunified with a biological parent before the age of 18?
*
Yes
No
Not Sure
If yes, at what age?
Are you still under court jurisdiction?
*
Yes
No
Not Sure
Which county and state last oversaw your foster care or guardianship case ?
*
Date of HS Graduation?
*
-
Month
-
Day
Year
Date
Did you attend a community college?
*
Yes
No
If you attended community college, what was your graduation date?
-
Month
-
Day
Year
Date
Name of current University?
*
How many units of college have you completed?
*
What is your major?
*
How many units/credits are you currently registered in?
*
Have you applied for FAFSA for this school year?
*
Yes
No
Do you have a financial aid award letter for this school year?
*
Yes
No
Unsure
Are you eligible for a tuition fee waiver?
*
Yes
No
Unsure
Do you qualify for a Chafee /ETV Grant?
*
Yes
No
Not Sure
Are you married?
*
Yes
No
Do you have children?
*
Yes
No
Do you currently have a job?
*
Yes
No
Total Gross Monthly Employment Income:
List all sources and amounts to pay for your education (scholarships, grants, loans):
*
List all debt that requires current monthly payments:
Are you connected to a foster youth support program at your school?
*
Yes
No
Do you have any mental health diagnosis?
*
Yes
No
If so, how do you care for yourself? (medication, therapy, etc)
*
Please tell us about your history. What brought you into foster care and/or homelessness?
*
Please tell us a bit about how you have persevered to make it into a University?
*
What is your current education, employment and living situation?
*
What are your goals for the future?
*
How will a monthly stipend and personal coaching from Inspire help you to reach your goals?
*
Please attach all transcripts:
*
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Please attach all transcripts:
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Please attach one personal reference from a teacher, employer, social worker, counselor or other mentor in your life:
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Most Current Financial Aid Award letter:
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Submit
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