Fortera Foundation Financial Assistance Application

Financial Assistance Application
Click here to view the Fortera Foundation Financial Assistance Eligibility Requirements.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Email*
example@example.com
College Email*
example@example.com
Academic year for which you are applying*
Are you a legal resident of the United States (or a resident with DACA status)?*

YesNo
Type of Financial Assistance Requested*

TuitionBooks / SuppliesChildcareHousingEmergency Hardship Expense
Are you interested in financial coaching or mentoring resources?*

YesNo
Please attach documentation verifying expenses for which you are requesting assistance.

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Why do you need the requested financial assistance?*
What goal does this assistance help you achieve?*
Total Family Monthly Income*
Total Family Annual Income*
Sources of Income*
Total Family Expenses*
Please provide proof of income by uploading the first two pages of most recent year of your Federal Tax Return - 1040. Other income verifications may be considered if you did not file a return. Please see chart below for accepted forms.*

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Accepted Proof of Income Documents
- Wage and Tax Statement or Form W-2 reporting total annual wages and providing a renter's overall income status;
- Paystubs proving proof of consistent income over a longer period of time;
- Form 1099-MISC
- Bank statements
- Federal Income Tax Return or Form 1040
- Social Security Benefits Statement
- Worker's Compensation Letter
What is your poverty status? (use charts below to determine your poverty status)*

0 to 200%200% or above
Marital Status*

Single (never married, widowed, divorced, legally separated)MarriedMarried, but living apart and your divorce will be final by the time the assistance is award
Parenting Status*

Custodial parent or guardian with physical custody (50% or more) of at least one dependent child (A dependent child is 18 years old or younger, older than 18 and still in high school, or a severely disabled adult living with and dependent on the student/parent applicant.)Noncustodial parentNo childrenChildren older than 18 years of age
Living Status*

I am the only adult in the home with my child(ren)I live with my parents or relatives and my child(ren)I live with my child(ren) and a roommate or friend who is NOT my partner or a co-parentI live with my children and a roommate who IS my partner (significant other) or a co-parent
Highest level of education completed*

High school graduateGED graduateCollege credits, but less than a bachelor's degreeBachelor's degree or higher
Have you completed or are you in the process of completing the Free Application for Student Aid (FAFSA) (not required for DACA students)?*

YesNo
Please upload one (1) of the following: Copy of your Student Aid Report (SAR) OR a letter from your school’s Financial Aid Office that states your approval or denial for financial aid during the term for which assistance is to be used. *

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If you did not apply for FAFSA, please provide an explanation below.
Name of University where you are enrolled or admitted *
Please submit proof of enrollment or admittance (class schedule for upcoming term, registrar verification or admittance letter).*

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Do you attend in person or online?*

In personOnlineBoth
In what year of study are you enrolled / admitted?*

FreshmanSophomoreJuniorSenior
What is your current cumulative GPA?*

0.0 to 1.992.0 or higherI have not attended college
*Please upload transcripts from all post-secondary schools you have attended, including your most recent term. If you have no college experience, provide your high school transcript or GED certificate.*

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