Resident Scholarship Application

Resident Scholarship Application
Section 1 – Applicant Information

*Required Field
Full Legal Name:

First NameMiddle NameLast NameSuffix
Preferred Name:
Date of Birth:

MonthDayYear
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Property Name
Unit Number
Length of Residency:
Upload a Copy of Your Valid ID:

Valid ID (Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Upload Proof of Residency (E.G., Lease, Utility Bill, Etc.):

Proof of Residency (Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Section 2 – Program Information
Institution:
Program or Field of Study:
Program Start Date:

MonthDayYear
Expected Completion Date:

MonthDayYear
Student ID (If Applicable):
Estimated Tuition or Program Cost:
Estimated Books/Equipment Cost:
Upload Proof of Enrollment or Admission:

Proof of Enrollment/Admission (Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Section 3 – GPA
Current or Most Recent GPA (Unweighted):
Section 4 – Financial Aid
Have You Applied for Other Financial Aid?
Please List All Financial Aid Sources (FAFSA, Employer, Scholarship, Etc.), Amounts (Awarded or Expected) and Status (Applied/Awarded/Pending):
Estimated Remaining Out-of-Pocket Cost After All Aid:
Upload Your Financial Aid Documentation

Financial Aid Documentation (Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Section 5 – School Billing Office

(Will Be Used to Facilitate Direct Payment if Awarded)
Name of Contact Person

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Upload a Tuition or Billing Statement:

(Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Section 6 – Reference
Name of Reference:

First NameLast Name
Relationship to Applicant:
Reference Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Upload Your Letter of Reference:

Reference Letter (Accepted File Types: PDF, DOC, DOCX, JPG, PNG)
Cancelof
Section 7 – Household Information
Head of Household (if Different):
Total Household Members:
Estimated Household Income:
Section 8 – Essay Questions

Responses Will Be Evaluated Based on Alignment with Career Goals, Economic Impact, Feasibility, and Overall Program Fit.
Describe the education, training, or certification you plan to pursue and the type of work you want to do after.
Explain how completing this program will improve your income, job stability, or career opportunities.
What challenges might you face while completing this program and how do you plan on handling them?
Describe a time you committed to something important (school, work, or personal) and how you followed through.
Is there any additional information you would like the Scholarship Review Committee to consider that was not addressed elsewhere in this application?
Section 9 – Statements
Statement of Accuracy and Release of Information

By signing below, I attest that all information provided on this application is accurate to the best of my knowledge. My signature also authorizes the educational institution and other third parties, as identified in this application, the ability to disclose all pertinent student information to Southeastern Housing Preservation, Inc. ("SHPI") (i.e., admission, enrollment, billing, and academic performance). I hereby give SHPI to potentially disclose the included information for non-commercial purposes. I understand that this information will not be used for exploitative means, but rather, to share portions of my testimony in order to encourage future participation and help secure the continued success of SHPI Scholarship Program.
Signature of Applicant
Date:

MonthDayYear
Statement of Educational Commitment

By signing below, I acknowledge that I am committed to furthering my education. I will strive to maintain satisfactory academic progress in each course. I understand that satisfactory academic progress is defined as maintaining a 2.75 GPA (or academic equivalent) or better each semester. I understand that my academic progress will be reviewed each semester in order to be considered for future scholarship disbursements.
Signature of Applicant
Date:

MonthDayYear
Residency Verification and Recommendation – for Site Manager

By signing below, I certify that the applicant is in good standing and I support their participation in the Scholarship Program.
Signature of Site Manager
Date:

MonthDayYear
Section 10 – Terms & Conditions
Scholarship Application – Terms & Conditions

Privacy and Data Use

Information collected through this application will be used solely for the purpose of evaluating eligibility and administering the SHPI Scholarship Program. Applicant information will be reviewed only by authorized SHPI staff and designated Scholarship Review Committee members.

SHPI does not sell or share applicant information with third parties except as necessary to verify eligibility, process payments to educational institutions or training providers, or as required by law. SHPI maintains reasonable administrative and technical safeguards to protect applicant information.

Confidentiality

SHPI will use the information provided in this application solely to evaluate eligibility, select scholarship recipients, administer scholarship awards, verify information, process payments, and comply with applicable legal requirements. Application information will be accessible only to authorized personnel and reviewers and will not be publicly disclosed without the applicant’s separate written consent.

Optional Publicity Release

Scholarship recipients may be invited to participate in SHPI publicity efforts intended to promote the SHPI Scholarship Program and encourage future participation. Participation is voluntary and is not a condition of receiving or renewing an award. SHPI will obtain the recipient’s separate written consent before using the recipient’s name, photograph, likeness, testimonial, educational information, or other personal information in any publication, website, social media post, press release, or promotional material. If the recipient is under 18, consent must also be provided by a parent or legal guardian.

Applicant Certification

By submitting this application, I certify that all information provided is true, complete, and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification from the program or revocation of any award.

Authorization and Consent

I authorize SHPI to verify the information provided in this application, including academic, financial, and residency information, as necessary to determine eligibility. I consent to the use of my information for purposes of administering the SHPI Scholarship Program.

Non-Discrimination

This program is administered without regard to race, color, religion, sex, national origin, disability, familial status, or any other protected characteristic.

Award Disclaimer

Submission of an application does not guarantee funding. Scholarship awards are subject to eligibility requirements, review by the Scholarship Review Committee, and availability of funds.

Payment of Funds

I understand that scholarship funds will be paid directly to the educational institution or training provider whenever feasible and may not be issued directly to me.

Multi-State Considerations

Applicants may attend educational institutions outside of North Carolina. SHPI will administer the program in accordance with applicable federal and North Carolina laws, and reasonable standards for handling applicant information.
Terms & Conditions – Certification

By signing below, I certify that I have reviewed and agree to be legally bound by the Terms and Conditions. I acknowledge receipt of the Terms and Conditions and consent to the use of electronic records and signatures. I understand that my electronic signature is intended to have the same legal effect as a handwritten signature.
Signature of Applicant (Certifying Terms & Conditions):
Date:

MonthDayYear
utm_source
utm_medium
utm_campaign
Should be Empty:

Resident Scholarship Application

Section 1 – Applicant Information

Section 2 – Program Information

Section 3 – GPA

Section 4 – Financial Aid

Section 5 – School Billing Office

Section 6 – Reference

Section 7 – Household Information

Section 8 – Essay Questions

Section 9 – Statements

Section 10 – Terms & Conditions