Living Free Center High School Diploma Scholarship Application Form

Living Free Center High School Diploma Scholarship Application (2022-2023)

The information provided on this form will be used by the High School Scholarship Committee to select recipients for scholarships. It is important that you give complete details concerning your college/career plans, activities and financial information.
BASIC INFORMATION
Student's Full / Legal Name *

First Name Last Name
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student Phone Number *

Area Code Phone Number
Student E-mail *
Student Birth Date *

Month Day Year
Gender *
Academics
Academic GPA
Class Rank
Estimated cost
Scholarship will cover the cost of Tuition in the amount of: $217.63

Student only Pays a one time Registration fee $39.99 plus an additional fee of $17.67 for processing and shipping after exam completion. Totaling $57.66

Breakdown of Payment:

-$217.63 Scholarship

$39.99 Registration fee

$17.67 Processing and Shipping fee

_____________________________

$57.66 (Your Payment)
The LIVING FREE CENTER Scholarship Foundation does not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, military status, or any other restricting classification in its selection of scholars.
PERSONAL DATA:

(optional scholarship identification for specific scholarships)
Ethnic Background (Check all that apply)

African/American Asian/Pacific Islander Portuguese Filipino Slavic Swiss American Indian Italian Chinese Puerto Rican Hispanic Vietnamese Japanese Other
Disability
Religious Affiliation (optional for scholarship eligibility)
Elementary School(s) Attended
REFERENCES:

Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.
Reference 1 Name (Position,Phone Number) *
Reference 2 Name (Position,Phone Number) *
Directions for Students 16yrs of Age

Complete only the items marked with an asterisk (*) if you do not want your student to be considered for the need-based scholarships. Stepparent information may replace Mother or Father's information: Please report earnings for the parent/stepparent who the student has lived with most of the time (over 50%) in the past twelve months. If the student lives with both parents equally then provide answers about the parent/stepparent who provides the most financial support.
Father/Stepfather/Guardian Name
Father/Stepfather Employer and Occupation
Mother/Stepmother/Guardian Name
Mother/Stepmother Employer and Occupation:
Number of dependents in home:
First generation to attend college?

Yes No
Father/Stepfather Annual Income :
Mother/Stepmother Annual Income :
Other income that can be used for educational purposes (inheritance, college funds, etc)-do not include home equity, IRA's or other retirement accounts (optional):
Other Income Type 1:
Other Income Amount 1:
Other Income Type 2:
Other Income Amount 2:
Please explain any unusual circumstances such as, child-support ending, emergency expenses, medical bills, seasonal work, unemployment, etc.
Needs-based Scholoarships Student/Parent Financial Information

If you and/or your student want to be considered for need-based scholarships, you will need to make available a copy of the first page of your public assistance information and you must complete the information requested below. All information supplied by you will be treated as confidential. If you chose not to submit any information, you/your student will not be considered for need-based scholarships. Most donors require a financial statement. If your financial circumstances change after you have submitted this form, please feel free to contact us. Complete this entire page if you want your student to be considered for need-based scholarships.
Case ID#: *
Upload public assistance documents *

Browse Files

Cancel of
Upload DL/ID *

Browse Files

Cancel of
STUDENT STATEMENT CONSIDERATION: *
Signature *

Clear
Signature of Parent

Clear
Submission Time *

Month Day Year Hour Minutes AM/PM Option
Should be Empty:

Living Free Center High School Diploma Scholarship Application (2022-2023)

BASIC INFORMATION

Academics

Estimated cost

PERSONAL DATA:

REFERENCES:

Directions for Students 16yrs of Age

Needs-based Scholoarships Student/Parent Financial Information