YAB Foundation Scholarship Application

Scholarship Information
The Yaqub A Brock Foundation for Giving is a 501(c)(3) charity that helps financially vulnerable youth access extracurricular activities such as sports, the arts, special-interest clubs, and technology. This includes scholarships and partnerships with other agencies to magnify community impact.

Application Period: Applications are reviewed, and can be submitted, year round.

Award: One or more qualified individuals will be awarded scholarships for financial assistance to cover costs and fees associated with participation in organziations that align with the mission of the Foundation. Each scholarship recipient can be awarded up to $2,000 one time per year.

Qualifications: Candidates must meet the following criteria to qualify for this award:

1. Applicant must be age 9-17 by 1st day of program participation.

2. Applicant must reside in the state of North Carolina, DC, Maryland, or Virginia.

3. Organization or program of interest must be extra-curricula in nature (outside of school) and relate to activities aligned with the mission of the Foundation. Sports, technology, nature, camp, art, and cooking are a few examples of eligible activities.

4. Demonstrated financial need. Parents/Guardians may be asked to provide copies of W-2 forms, pay stubs, and/or describe household expenses.

*Please note that 100% of scholarship awards will be dispersed to the organization that recipient will attend. No monies will be given directly to recipient or parents/guardians.

Scholarship Application
Candidate Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address*
Phone #

Area CodePhone Number
Email*
School*
Grade*
Tell us why you want to participate in this activity*

0/250

Parent/Guardian Complete the Following
Name of Parent(s) or Caregiver(s)*
Address*
Phone #*
Email Address*

Program Information
List the name, address, and phone number of the organization or program that the applicant wants to attend*
List Program Start Date*
Describe the program and what the applicant will be doing while there *
Describe how the funds will be used (i.e., uniform, supplies, enrollment fees, etc)*
Has Applicant Already Registered*
Does organization offer financial assistance?*

Financial Eligibility - To be completed by parent/guardian(s)
Do you receive SNAP, TANF, or other public assistance?*
List the total monthly income from earnings, public assistance, and alimony/child support.*
Are there any special circumstances you feel we should know during the application review process?
INCOME VERIFICATION MUST BE CURRENT AND INCLUDE TWO (2) OF THE FOLLOWING:

1. W-2

2. PAYSTUB

3. VOUCHER

4. SSI

Email financial verification forms to:

financialeligibility@yabfoundation4giving.org

*This information will be kept confidential and used only in determining financial eligibility*

*Application is not complete, and will not be reviewed, until all paperwork is received*

I certify that to my knowledge, all information is true
Signature (Please type your name)*
Please Complete Verification*
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