2022 Patsy Takemoto Mink Education Support Award Application

2022-23 Education Support Award Application

Submission Deadline: August 1, 2022
REQUIRED APPLICANT CRITERIA: Applicants must meet all criteria below, as posted on our website. Please review all criteria prior to submitting your application. In short, applicants must meet all of the following conditions:
1. must be a woman, at least 17 years of age;
2. must be a mother, with minor children;
3. must be pursuing a first degree at a postsecondary level of education (e.g., vocational, associate's, bachelor's, master’s, doctoral) AND degree program must add to level of education accomplished (e.g., bachelor's after associate's, or advanced degree after a bachelor's)
4. pursuit of degree/certificate must be at an institution that does not discriminate on the basis of sex/gender; race/ethnicity; lgbtq+ status/identity; religion; disability; immigration status;
5. must be enrolled at a not-for-profit, accredited institution or program in the U.S. during the 2022-23 academic year. Not sure if your institution is not-for-profit? Here's a great look-up resource to find out .
6. must be low-income: all annual family income less than $20,000 for a family of 2; less than $24,000 for a family of 3; less than $28,000 for a family of 4.
INSTITUTION IN WHICH YOU ARE ENROLLED IN 2022-23 *
NAME OF INSTITUTION - DO NOT ABBREVIATE - IN WHICH YOU WILL BE ENROLLED IN 2022-23
I wish to proceed to the Patsy Takemoto Mink Education Support Award Application *

CONTINUE TO APPLICATION
Thank you for your interest in the Patsy Takemoto Mink Education Foundation.

Unfortunately, the institution you have entered is a for-profit institution.

As noted above and posted on our website, applicants must be enrolled in a not-for-profit, accredited institution or program in the U.S. during the 2022-23 academic year.

If you do not know if your institution is not-for-profit, try this helpful tool at https://nces.ed.gov/collegenavigator or contact your institution directly.
ALL APPLICANTS - PLEASE READ

IMPORTANT NOTES ABOUT:
- SAVING TO CONTINUE YOUR APPLICATION AT A LATER TIME
- SUBMITTING YOUR APPLICATION
- POST-SUBMISSION EDITS
The ACCURACY of YOUR EMAIL ADDRESS is CRITICAL to these processes. PLEASE ENSURE IT IS ENTERED CORRECTLY.

TO SAVE & CONTINUE YOUR FORM AT A LATER TIME: You may continue to work on your application-in-progress over time until August 1 without formally submitting. Here are the necessary steps:
- Scroll to the bottom of the Application and CLICK THE "SAVE & CONTINUE LATER" BUTTON.
- A JotForm window will pop up asking you to Save Your Progress.
- SELECT THE "Skip Create an Account" option at the very bottom of the pop-up window (DO NOT create a personal JotForm account).
- A new window will pop up stating: "Your form has been saved as a draft. If you want to continue your form later, please enter the email address you would like to send the link to."
- ENTER YOUR EMAIL ADDRESS, then CLICK "SEND LINK" Button to the right. If you do not complete this step you will not be able to complete your application in progress and will need to begin again.
- You will receive an email at the address you provided, with your dedicated session ID link for your application-in-progress. SAVE THAT EMAIL. You will need that link to access your application-in-progress until you formally submit in full.
- You MUST HIT THE "SAVE & CONTINUE" BUTTON in each subsequent session in which you enter new information but do not submit. If you do not either Save or Submit the application in full during that session any new information entered will not be retained.
SUBMISSION OF YOUR APPLICATION: Formal submission of your application occurs when you hit the SUBMIT button and not before, regardless of any information saved pre-submission. NOTE: All fields marked with a red asterisk* are required fields.

POST APPLICATION SUBMISSION EDITS: Once you formally submit your application you will receive a confirmation email that your application has been submitted to the Foundation, along with a NEW LINK for any post-submission edits.
CRITERIA AFFIRMATION *
SECTION 1: Applicant Information
FIRST Name *
MIDDLE Name
LAST Name *
YOUR E-Mail Address: *

Confirmation Email Email address of the APPLICANT
YOUR Residential Address: *

Street Address

Address Line 2 (Apt #, Floor, etc.)

City State

Zip Code Country
Is your Mailing Address the same as your Residential Address above? *

Yes No
YOUR Mailing Address (if different from Residence):

Street Address

Address Line 2 (PO Box, Apt #, Floor, etc)

City State / Province

Postal / Zip Code Country
YOUR Phone Number: *
YOUR Birth Date *

Month Day Year
Age *
YOUR Social Security Number

I have a SS# or ITIN I do NOT have a SS# or ITIN
Last Four (4) Digits of YOUR SS# or ITIN
EDUCATION LEVEL you have OBTAINED as of July 2022: *
EXAMPLE: High school diploma, GED, Associate's, BA, MA, PhD,
Most RECENT education/skills PROGRAM COMPLETED: *

0/20
DATE you COMPLETED most recent education/skills program above: *

Month Day Year
SECTION 2: Enrollment Information for 2022-23
INSTITUTION IN WHICH YOU ARE ENROLLED IN 2022-2023 *
NAME OF INSTITUTION IN WHICH YOU WILL BE ENROLLED IN 2022-23 - DO NOT ABBREVIATE
INSTITUTION Website *
example: https://windward.hawaii.edu/
INSTITUTION Mailing Address: *

Address

Address Line 2

City State

Zip Code
Date You FIRST ENROLLED in Institution Above *

Month Day Year
Institution's ACADEMIC YEAR START DATE for 2022-23 *

Month Day Year
PROGRAM/MAJOR in which You are Enrolled *
PROGRAM or MAJOR in which you will be enrolled in 2022-23
What DEGREE LEVEL/CREDENTIAL are you seeking? *
EXAMPLES: Associates, BA, MA, MSW, PhD, etc.
DATE YOU EXPECT to achieve degree level/credential sought: *

Month Day Year
SCHOOL/PROGRAM CONTACT Name *

Institutional Contact FIRST Institutional Contact LAST
TITLE of School/Program Contact listed above: *
Example: Administrator, Registrar, Adviser...
E-MAIL of School/Program Contact listed above: *
PHONE # of School/Program Contact listed above: *
CAMPUS ADDRESS of School/Program Contact listed above *

Address

Address Line 2

City State / Province

Postal / Zip Code
SECTION 3: Financial Information
2022-23 TUITION Amount ($): *
Enter Amount in Dollars ($)
OTHER education-related EXPENSES in 2022-23 ($): *

Enter total Dollar Amt of Other Education-related Expenses, followed by itemization 0/50
Have you applied for funding from other sources? *

Yes No
OTHER FUNDING SOURCES you have applied to (one line for each source):
For tax purposes, ARE YOU A DEPENDENT? *

Yes No
Enter the ANNUAL INCOME of the PERSON WHO CLAIMS YOU as DEPENDENT:
Enter Amount in Dollars
YOUR MONTHLY INCOME, list all sources (one line for each source): *
Do OTHERS CONTRIBUTE to the HOUSEHOLD INCOME? *

Yes No
OTHER HOUSEHOLD INCOME, list all sources (one line for each source):
YOUR MONTHLY RENT/MORTGAGE: *
Enter Monthly Rent/Mortgage in Dollars
SECTION 4: Household and Personal Information
Household Members *
If yes, enter the ages of your children living with you:
Separate by comma
Race/Ethnicity of Applicant *
Disability of Applicant or Dependent *
SECTION 5: Professional/Educational References

Please provide complete information for two professional or educational references (e.g. employer, supervisor, union representative, teacher, mentor, or colleague).
Professional/Educational Reference #1 (employer, supervisor, union representative, teacher, mentor, or colleague)
Ref 1 Name *

First Name Last Name
Ref 1 School or Business *
With what institution (school, business, etc) is reference #1 affiliated
Ref 1 Relation to applicant: *
How does reference #1 know you (employer, teacher, etc)
Ref 1 Email: *
Email address of reference #1
Ref 1 Phone Number: *
Phone # of reference #1
Ref 1 Postal Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Professional/Educational Reference #2 (employer, supervisor, union representative, teacher, mentor, or colleague)
Ref 2 Name *

First Name Last Name
Ref 2 School or Business *
With what institution (school, business, etc) is reference #2 affiliated
Ref 2 Relation to applicant: *
How does reference #2 know you (employer, teacher, etc)
Ref 2 Email: *
Email address of reference #2
Ref 2 Phone Number: *
Phone # of reference #2
Ref 2 Postal Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
SECTION 6: Short-Answer Questions

Please respond briefly - in a few sentences, less than 100 words - to the following five (5) questions.
1. Describe the program in which you are/will be enrolled this year: *

0/200
2. How did you decide on the educational pursuit? *

0/200
3. What was your educational experience up to now? *

0/200
4. What are your educational goals? *

0/200
5. What will an Educational Support Award help you accomplish? *

0/200
SECTION 7: Short Essay
In approximately 500 words, tell us what else you would like us to know about your personal and educational history. *

Drag bottom right corner of text box to expand 0/1000
FP HIDDEN

Type option 1
Current Date *

Month Day Year
Date
Verification *
Should be Empty:

2022-23 Education Support Award Application

SECTION 1: Applicant Information

SECTION 2: Enrollment Information for 2022-23

SECTION 3: Financial Information

SECTION 4: Household and Personal Information

SECTION 5: Professional/Educational References

SECTION 6: Short-Answer Questions

SECTION 7: Short Essay