2024 Jaxson Scholar Application

2024 Jaxson Scholar Application
The Jaxson William Augustus Swank Foundation (JWAS) has begun accepting applications for the 2024 Jaxson Scholarship recipient. Children between the ages of 2.5 and 5 years are eligible to apply for the 2024-2025 school year.

Eligibility includes the following:
- The applicant must be between the ages of 2.5 to 5-years-old (entering pre-school or kindergarten for the 2024-2025 school year).
- The child must show readiness to be in a primary environment (ability to follow direction, accept a gentle no, be potty trained, etc.).
- Families must qualify within our income guidelines of at or below 250% of the federal poverty level ($75,000 for a family of 4).
- While families need not reside in St. Joseph County (IN), all Jaxson Scholars are expected to enroll at a local school in the area.
- Jaxson Scholars and JWAS Families are expected to attend at least 75% (8 of 10) of our annual character and leadership development programming each year.
- Families must be actively engaged at their child’s school and in their learning progress. Families are expected to be sound moral examples of character while serving our community at large.
- Background checks will be run on the parents/guardians of the finalist applicants.
- I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this applicaiton.
The mission of the Jaxson William Augustus Swank Foundation is to perpetuate Jaxson's loving memory by providing financial assistance to deserving individuals from preschool through college and to support each recipient in achieving their potential to obtain academic distinction while developing good moral character as future leaders. The Jaxson William Augustus Swank Foundation helps eligible families pay for academic tuition for their child from preschool through college.

To be considered for the 2024-2025 school year, applications must be completed by the deadline, Monday, October 30, 2023. Submitting an application does not guarantee acceptance as a Jaxson Scholar. The JWAS selection committees determine a child's acceptance into our Jaxson Scholarship program. Finalists will participate in a family playdate and possible family interview for the child applying for the scholarship. JWAS will notify the applicants of their application status no later than December 1, 2023. If selected, the applicant and the family must apply to the chosen school and complete the FACTS (financial aid) agreement no later than February 15, 2024 and be formally accepted by JWAS Foundation as a Jaxson Scholar.

For more information about JWAS and our Jaxson Scholar application process, please contact our Executive Director, Jeanie Shuck, at 888.915.4755 or jshuck@jwasfoundation.org.

Jaxson Scholar Application Instructions and Document Checklist
INSTRUCTIONS
- Parent(s)/guardian(s) must sign and date the application form. In two-parent households, both parents must sign.
REQUIRED DOCUMENTS

The following documents are required to determine eligibility for the Jaxson Scholarship. Please mail or email COPIES of the following documents. You may also choose to upload documents below.

BIRTH CERTIFICATE
- Submit a copy ONLY for the child who is applying for the scholarship. The birth certificate must be issued from the Department of Health.
OTHER DOCUMENTS
- Please submit applicable documents stated on the "Household Income Document."
- Please submit documentation if a second parent/guardian is not present.
Please note that incomplete applications may delay processing or result in the application not being processed or considered.

Thank you for your interest in the Jaxson Scholarship!

Please submit ALL required documents via mail, email, or upload.

JWAS Foundation
Attn. Jeanie Shuck
3900 Edison Lakes Pkwy Ste 201
Mishawaka, IN 46545

jshuck@jwasfoundation.org
Submit required documents (maximum size per file is 100MB)

Browse Files

Cancelof
Child/Applicant Information
Child's Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
MM/DD/YYYY
Age on Sept. 1, 2024*
Current School*
City of Current School *
Days/Hours Attending Current School*
Ethnicity*
Religious Affiliation*
Primary Language Spoken in the Home*
How did you hear about JWAS Foundation and the Jaxon Scholarship Program?*

Parent/Guardian #1 Information

Information on Both Parents is Required
Parent/Guardian #1*

PrefixFirst NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Marital Status:

MarriedWidowedSeparatedDivorcedSingle
Education Completed Thus Far*
Occupation and Place of Employment*
Length of Employment:*
Has Parent/Guardian #1 ever been convicted of a felony which has not been expunged?*

YesNo
If yes, please explain:
Is there a Second Parent/Guardian?*

YesNo
If there is not a second parent or guardian, please explain below and submit documentation.

Parent/Guardian #2 Information
Parent/Guardian #2

PrefixFirst NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Email
example@example.com
Marital Status:

MarriedWidowedSeparatedDivorcedSingle
Education Completed Thus Far
Occupation and Place of Employment
Length of Employment:*
Has Parent/Guardian #2 ever been convicted of a felony which has not been expunged?

YesNo
If yes, please explain:

Household Information

Please provide the following information for each family member currently living in your home including the parent(s)/guardian(s) listed above and the child for whom you are applying. Be sure to specify the relationship of the individuals living in the home.

	Full Name (First, Middle, Last)	Relationship to Potential Jaxson Scholar	Sex (M or F)	Birthdate	Marital Status
1
2
3
4
5
6
7
8
9
10

Total number of individuals living in the home: blank*

Household Income

Fill in the amount of each parent or guardian's monthly income for each category below. If not applicable, please list n/a for not applicable. Please provide two months of supporting documentation for ALL sources of income.
Name of Parent/Guardian #1*

Parent/Guardian #1 Sources of Income*

	Dollar Amount	Frequency of Payment	Annual Gross Income
Wages/Salaries (before deductions) Document Needed: Tax Return Signed
Net Income from Self-Employment Document Needed: Tax Return & Schedule C
Public Assistance: TANF/AFDC Document Needed: Statement
Child Support/Alimony Document Needed: Current Order or Printout
Social Security/SSI Benefits (SS Award Ltr is sent to you Nov/Dec of each year, keep for this purpose) Document Needed: SS - Award Ltr SSI - Printout
Unemployment Insurance Document Needed: Online Statement
Workers Comp Document Needed: Statement
Veteran’s Benefits Document Needed: Statement
Military Pay (does not include hostile fire pay) Document Needed: LES Statement

If you have OTHER income, please list the types and amounts below. Please also include the Annual Gross Income for each. Please provide the documentation to show income.
Type, Amount (with frequency) and Total Gross Income
Parent/Guardian #1 Total Annual Gross Income: blanks*
I,Full name*, certify that the information given above is true and complete to the best of my knowledge and that I have not falsified any information. Date
Signature of Parent/Guardian #1*

Clear
Name of Parent/Guardian #2*

Parent/Guardian #2 Sources of Income

	Dollar Amount	Frequency of Payment	Annual Gross Income
Wages/Salaries (before deductions) Document Needed: Tax Return Signed
Net Income from Self-Employment Document Needed: Tax Return & Schedule C
Public Assistance: TANF/AFDC Document Needed: Statement
Child Support/Alimony Document Needed: Current Order or Printout
Social Security/SSI Benefits (SS Award Ltr is sent to you Nov/Dec of each year, keep for this purpose) Document Needed: SS - Award Ltr SSI - Printout
Unemployment Insurance Document Needed: Online Statement
Workers Comp Document Needed: Statement
Veteran’s Benefits Document Needed: Statement
Military Pay (does not include hostile fire pay) Document Needed: LES Statement

Parent/Guardian #2 Total Annual Gross Income: blanks
I, Full name, certify that the information given above is true and complete to the best of my knowledge and that I have not falsified any information. Date
Signature of Parent/Guardian #2

Clear
Are any additional individuals contributing to the household income?*

YesNo
If yes, please list the types and amounts below. Please also include the Annual Gross Income for each. Please provide the documentation to show income.
Type, Amount (with frequency) and Total Gross Income

References

Please provide two non-family member references.
Reference #1: Current Employer if Applicable*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to Family if Not Employer
How Long You've Been Employed or Known this Reference*
Reference #2*

First NameLast Name
Phone Number*

Area CodePhone Number
How Long You've Known this Reference*

Jaxson Scholar and JWAS Parent Cooperative Agreement

We value our consistent and ongoing relationships with our JWAS families. To help the JWAS Foundation cultivate confidence and success in yours, please initial the statements below.
Initial* I understand that if my child becomes a Jaxson Scholar my Jaxson Scholar/family will be expected to participate in leadership development classes, retreats, social activities, etc. with other JWAS families, as well as perform community service as a part of the Jaxson Scholarship.
Initial* I understand that if my child becomes a Jaxson Scholar there will be expectations around my Jaxson Scholar’s attendance, participation, and overall behavior at school. I understand that I am a major contributing factor in my child’s educational success and will actively participate in monthly, quarterly, and annual meetings regarding my child’s education, if needed. I will communicate and seek solutions to any challenges that may arise that could prohibit my child’s education endeavors.
Initial* I understand that if my child becomes a Jaxson Scholar I will be required to review the scholarship expectations and update our family income status and participation guidelines on an annual basis.
Initial* I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty my render for refusal of this application.
Scholar Applicant Name: full name* Date: MM/DD/YYYY*
Parent/Guardian #1 Name: full name* Date: MM/DD/YYYY*
Signature of Parent/Guardian #1*

I hereby certify that all information is true and correct to the best of my knowledge. I understand that any false statement may disqualify my child’s Jaxson Scholar application. Clear
Parent/Guardian #2 Name: full name Date: MM/DD/YYYY
Signature of Parent/Guardian #2

I hereby certify that all information is true and correct to the best of my knowledge. I understand that any false statement may disqualify my child’s Jaxson Scholar application. Clear
Should be Empty:

2024 Jaxson Scholar Application

Jaxson Scholar Application Instructions and Document Checklist

Child/Applicant Information

Parent/Guardian #1 Information

Parent/Guardian #2 Information

Parent/Guardian Perspective

Household Information

Household Income

References

Jaxson Scholar and JWAS Parent Cooperative Agreement