2027 Jaxson Scholar Application

2027 Jaxson Scholar Application
Thank you for your interest in the Jaxson Scholarship! The Jaxson Scholarship helps eligible families pay for academic tuition and services for their child from preschool through higher education and provides leadership programming for the entire family throughout the year.
The mission of the Jaxson William Augustus Swank Foundation is to perpetuate Jaxson's loving memory by nurturing selected individuals educationally, emotionally, and socially from preschool through higher education in achieving their greatest potential while developing strong moral character as future leaders through our Trilogy of Care.
The Jaxson William Augustus Swank Foundation (JWAS) is accepting applications for the 2027 Jaxson Scholarship. Children between the ages of 2.5 and 5 years are eligible to apply for the 2027-2028 school year.
Eligibility includes the following:
- The applicant must be between the ages of 2.5 to 5-years-old by October 30, 2026 AND entering pre-school or kindergarten for the 2027-2028 school year.
- The child must show readiness to be in a primary learning environment (can follow directions, accept a gentle no, be potty trained, etc.).
- Families must qualify within our income guidelines of up to 250% above the Federal Poverty Level ($82,500 or below for a family of 4).
- While you do not need to live in St. Joseph County (IN), all Jaxson Scholars are expected to enroll at a local school in the area.
- Jaxson Scholars and JWAS Families are expected to attend at least 75% of our annual leadership programming (8 out of 10 programs) each year.
- Families must be actively engaged in their child's education and be positive role models in the community.
- Background checks will be run on the parents/guardians of the finalist applicants.
- I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application.
To be considered for the 2027-2028 school year, applications must be completed by the deadline, Friday, October 30, 2026. Submitting an application does not guarantee acceptance as a Jaxson Scholar. The JWAS selection committee determines a child's acceptance into our Jaxson Scholarship program. Finalists will participate in a playdate and possible family interview for the child applying for the scholarship. JWAS will notify the applicants of their application status no later than December 3, 2026. If selected, the applicant and the family must apply to the chosen school and complete the school's financial aid application no later than February 15, 2027 to be formally accepted by the JWAS Foundation as a Jaxson Scholar.
For more information about JWAS and our Jaxson Scholar application process, please contact our Executive Director, Jeanie Shuck at jshuck@jwasfoundation.org.

Jaxson Scholar Application Instructions and Document Checklist
INSTRUCTIONS
- Parent(s)/guardian(s) must sign and date the application form. In two-parent households, both parents must sign.
REQUIRED DOCUMENTS
The following documents are required to determine eligibility for the Jaxson Scholarship. Please mail or email COPIES of the following documents. You may also choose to upload documents below.
BIRTH CERTIFICATE
- Submit a copy ONLY for the child who is applying for the scholarship. The birth certificate must be issued from the Department of Health.
OTHER DOCUMENTS
- Please submit applicable documents stated on the "Household Income Document." The past 8 weeks of paystubs, 2025 W2, and other supporting documentation for ALL sources of income.
- Please submit documentation if a second parent/guardian is not present.
Please note that incomplete applications may delay processing or result in the application not being processed or considered.
Please submit ALL required documents via mail, email, or upload.
File Upload

Cancelof
JWAS Foundation
Attn. Jeanie Shuck
3900 Edison Lakes Pkwy. Suite 201
Mishawaka, IN 46545
jshuck@jwasfoundation.org
2

Child/Applicant Information
Child's Name
Address
Date of Birth
Age on October 30, 2026
Current School
City of Current School
Days/Hours Attending Current School
Ethnicity
Religious Affiliation
Primary Language Spoken in the Home
How did you hear about JWAS Foundation and the Jaxson Scholarship Program?
Parent/Guardian #1 Information
Information on both parents is required.
Parent/Guardian #1
Address
Cell Phone Number
Format: (000) 000-0000.
Email
example@example.com
Marital Status
Years of Education Completed
Degrees Earned
Current Occupation
Employer
Start Date - Please include employment history of last two years (Fall 2024-Fall 2026) if different from current employment.
Has Parent/Guardian #1 ever been convicted of a felony which has not been expunged?
Is there a Second Parent/Guardian?
3

Parent/Guardian #2 Information
Parent/Guardian #2
Address
Cell Phone Number
Format: (000) 000-0000.
Email
example@example.com
Marital Status
Years of Education Completed
Current Occupation
Employer
Start Date - Please include employment history of last two years (Fall 2024-Fall 2026) if different from current employment.
Has Parent/Guardian #2 ever been convicted of a felony which has not been expunged?
Parent/Guardian Perspective
We want to know your child's personality, needs, and the values that shape your family. Please answer the following questions about your child.
How would you describe your child's personality?
What are some of your child's interests and favorite activities?
Does your child have a nap routine? If so, please describe.
Does your child have a nighttime routine? If so, please describe. What time does he/she go to bed?
Does your child have any fears? If so, please describe. What techniques do you use to comfort your child?
Is your child potty trained? What assistance does he/she need?
Does your child regularly spend time with children his/her own age? If yes, how does he/she interact in groups?
Does your child have nutrition/health needs or allergies? If so, please describe.
Does your child have any special needs that the JWAS Foundation should be aware of? If so, please explain.
4

Areas of Concern (check all that apply)
Please explain any checked areas of concern.
What methods of discipline or guidance do you use at home?
Why is your child's education important to you?
Why do you think your child would be a great Jaxson Scholar?
What obstacles do you think might get in the way of your child's success in school?
Who in your community supports your child's academic success?
How does your family encourage leadership, kindness, or service?
What would being a part of the Jaxson Scholarship program mean to your family?
Please share what a typical weekend looks like for your family.
What is one way your family has shown strength as a unit? How has that shaped who you are as a family today?
Household Information

This section helps us understand who lives in your home and verifies eligibility. Please list everyone living in your home, including the child applying for the scholarship.

Rows	Full Name (First, Middle, Last)	Relationship to Potential Jaxson Scholar	Sex (M or F)	Birthdate	Marital Status
1
2
3
4
5
6
7
8
9
10

Total number of people who live in household:
5

Household Income
Fill in the amount of each parent or guardian's monthly income for each category below. If not applicable, please list n/a for not applicable. Please provide the past 8 weeks of paystubs, 2025 W2, and other supporting documentation for ALL sources of income.
Name of Parent/Guardian #1

Parent/Guardian #1 Sources of Income

Rows	Dollar Amount	Frequency of Payment	Annual Gross Income
Wages/Salaries (before deductions) Documents Needed: past 8 weeks of paystubs and 2025 W2
Net Income from Self- Employment Document Needed: Tax Return & Schedule C
Public Assistance: TANF/AFDC Document Needed: Statement
Child Support/Alimony Document Needed: Current Order or Printout
Social Security/SSI Benefits (SS Award Ltr is sent to you Nov/Dec of each year, keep for this purpose) Document Needed: SS - Award Ltr SSI Printout
Unemployment Insurance Document Needed: Online Statement
Workers Comp Document Needed: Statement
Veteran's Benefits Document Needed: Statement
Military Pay (does not include hostile fire pay) Document Needed: LES Statement

Parent/Guardian #1 Total Annual Gross Income:
I, First Name* Last Name* , certify that the information given above is true and complete to the best of my knowledge and that I have not falsified any information.
Signature of Parent/Guardian #1
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
6

Name of Parent/Guardian #2

Parent/Guardian #2 Sources of Income

Rows	Dollar Amount	Frequency of Payment	Annual Gross Income
Wages/Salaries (before deductions) Documents Needed: past 8 weeks of paystubs and 2025 W2
Net Income from Self- Employment Document Needed: Tax Return & Schedule C
Public Assistance: TANF/AFDC Document Needed: Statement
Child Support/Alimony Document Needed: Current Order or Printout
Social Security/SSI Benefits (SS Award Ltr is sent to you Nov/Dec of each year, keep for this purpose) Document Needed: SS - Award Ltr SSI Printout
Unemployment Insurance Document Needed: Online Statement
Workers Comp Document Needed: Statement
Veteran's Benefits Document Needed: Statement
Military Pay (does not include hostile fire pay) Document Needed: LES Statement

Parent/Guardian #2 Total Annual Gross Income:
I, First Name* Last Name* , certify that the information given above is true and complete to the best of my knowledge and that I have not falsified any information.
Signature of Parent/Guardian #2
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are any additional individuals contributing to the household income? If so, please list their name and their annual gross income.
7

References
Please provide two non-family member references.
Reference #1 (Current Employer if Applicable)
Name
Relationship
Phone Number
Format: (000) 000-0000.
Length Known
Reference #2
Name
Relationship
Phone Number
Format: (000) 000-0000.
Length Known
8

Jaxson Scholar and JWAS Parent Cooperative Agreement
We value our ongoing relationships with our JWAS families. Your involvement is key to your child's success. To help the JWAS Foundation cultivate confidence and success in yours, please initial the statements below.
I understand that if my child becomes a Jaxson Scholar my Jaxson Scholar/family will be expected to participate in leadership development classes, retreats, social activities, etc. with other JWAS families, as well as perform community service as a part of the Jaxson Scholarship.
I understand that if my child becomes a Jaxson Scholar there will be expectations around my Jaxson Scholar's attendance, participation, and overall behavior at school. I understand that I am a major contributing factor in my child's educational success and will actively participate in monthly, quarterly, and annual meetings regarding my child's education, if needed. I will communicate and seek solutions to any challenges that may arise that could prohibit my child's educational endeavors.
I understand that if my child becomes a Jaxson Scholar I will be required to review the scholarship expectations and update our family income status and participation guidelines on an annual basis.
I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application.
Scholar Applicant Name:

First NameLast Name
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
9

Parent/Guardian #1 Name:

First NameLast Name
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of Parent/Guardian #1
Parent/Guardian #2 Name:

First NameLast Name
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of Parent/Guardian #2
10
Should be Empty:

2027 Jaxson Scholar Application

Jaxson Scholar Application Instructions and Document Checklist

INSTRUCTIONS

REQUIRED DOCUMENTS

BIRTH CERTIFICATE

OTHER DOCUMENTS

Child/Applicant Information

Parent/Guardian #1 Information

Parent/Guardian #2 Information

Parent/Guardian Perspective

Household Information

Household Income

References

Jaxson Scholar and JWAS Parent Cooperative Agreement