Anne Nymark Furthering Education Young Adult Grant Application

Application and Personal Information

Note: Each question with an * is required and must be answered.

First name

(Enter your name as it appears on your ID/Driver’s License. Do not use a nickname):

Last name

Preferred first name

(or nickname)

Middle initial

Email

(We must have an accurate email address to notify award status.)

Permanent Home Street Address

(not school address)

City

State

ZIP code

Cell phone number where we can call or text you

(###-###-####)

What is the primary language spoken in your home?

Race

Sex

Ethnicity

What chronic medical condition(s) do you have?

At what age were you diagnosed?

Is your condition in remission?

Are you a foster youth or ward/dependent of the court?

Parent/Guardian Info

Parent/Guardian 1 Name

Parent/Guardian 1 Relationship

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Relationship

Parent/Guardian 2 Phone

High School/GED

Due to my health, I have not completed High School/GED, but would like to continue my education/training. (check box if true, otherwise leave blank)

High School/GED Name (if home schooled, please indicate):

High School/GED City:

Do you have a 504 Plan or IEP?

If applicable, cumulative GPA

If applicable, date of graduation:

What is your highest level of education obtained (GED, High School, some college, AA, college degree)?

Have you already been admitted?

What is your proposed start date?

Where will you be attending and address?

Website of educational/training program

What is your proposed career choice?

Based upon the previous definitions, you are:

Do you qualify for Free and Reduced Lunch?

Are you currently employed?

Have any of your parents, step-parents, caregivers or legal guardians attended college? (Answer for whomever has the highest education)

Who currently provides your primary financial support?

How many total people are living in your household? (Include yourself)

How many members of your family will be attending college/educational programs/certifications/training and are supported by your primary financial support? (include yourself)

Has anyone in your family received PPF funding before?

Optional Financial Information

If applicable, ask your parent(s), step-parent, or legal guardian the following questions and input their answers. If your parents are separated or divorced, answer the questions for the parent with whom you live.

If applicable, you can supply a copy of your Student Aid Report (SAR), which will be available to you if you complete the FAFSA Application (https://studentaid.gov/h/apply-for-aid/fafsa). You may also be required to provide documentation, such as your parent(s), step-parent or legal guardian’s federal tax returns or verification of benefits and original signature to verify your responses.

What is your household's total ANNUAL income from all sources, including step-parent(s)?

(Do not include student's income)

On average, how many hours per week do you work?

If you work, what is your monthly work income?

Projected Financial Resources

If a resource listed below does not apply to you, simply enter "0". Please do not leave anything blank - do your best to estimate the amounts for each of the resources listed below.

Student savings

If you have received your Student Aid Report (SAR), what is your Estimated Family Contribution (EFC)?

Expected Family Contribution (EFC) is found on Page 1 of your SAR. If your family is unable to contribute the EFC listed on Page 1 of your SAR, please: (1) list the amount your family will be able to contribute; and (2) explain why your family will be unable to contribute the amount listed on your SAR. How to download a SAR Report

Explanation

Do you have any other sources of funds, subsidized or unsubsidized, for supporting your education/training, such as loans, work study, student employment, scholarships, fellowships, grants, paid internship, financial awards, etc.?

If yes, please list with total amount:

If yes, please list with total amount: (copy)

Activities, Volunteer Services, Work

List up to 6 school/community activities (sports, clubs, volunteering, etc.) you have participated in over the last 4 years. Include activities, hours per year, number of years, and the position held/honors or awards received. If you do not have enough room to list all of your achievements, please prioritize and list only what you consider to be the most important. (250 words max)

If you have no response for this section, please write "N/A" and continue to the next section.

Activities:

Estimated Total Hours in the past year Invested in Activities:

Budget

Are there any special family circumstances (e.g., divorce, job loss, illness, debts, etc.) or unusual expense(s) preventing you from receiving financial assistance from your parents or otherwise contributing to your current financial need? Why do you need assistance?

Budget: Please explain how you will use funds if you receive the grant (Please include specific costs/fees)?

(Max: 250 words)

Time to Brag, Share, and Celebrate You

Personal Essay Questions: (You have a choice of either writing your responses to these 3 questions below or by emailing a short 3 minute video (rochelle.lentini@gmail.com) about these 3 questions.)

What dreams/goals (career, personal, and humanitarian) do you have for your future? What specific strengths will help you achieve your goals?

(Max: 300 words)

Describe the most significant challenge you have faced and what it took to overcome this challenge.

(Max: 300 words)

Things to consider: A challenge could be personal, or something you have faced in your community or school. How has this challenge affected your academic achievement? Why was the challenge significant to you? This is a good opportunity to talk about any obstacles you’ve faced and what you’ve learned from the experience. How did it shape you? Did you have support from someone else or did you handle it alone? If you’re currently working your way through a challenge, what are you doing now, and does that affect different aspects of your life? For example, ask yourself, “Because of this challenge, how has my life changed at home, at my school, with my friends or with my family?”

We read hundreds of applications. What is UNIQUE about you? Why should we choose you for a grant?

(Max: 300 words)

Applicant Agreement

Grant Eligibility: Candidates must be enrolled in an educational program within the United States. Grant recipients are expected to remain in good standing with their training/educational program for the full grant term.

Grant Revocation/Enrollment Failure: A grant recipient who does not pursue intended education/training during the grant term will forfeit funds to another candidate as selected by PPF and grant committee.

I agree to ALL CRITERIA in the Scholarship Applicant Agreement Date (MM/DD/YYYY):

I agree to ALL CRITERIA in the Scholarship Applicant Agreement Date

Date / Time

Authorization and Certification

Photo and Media Release Waiver

Do you give PPF Photo and Media release permissions as stated in the above terms and conditions?

Permission is hereby given to PPF to use, reproduce, and/or publish my text, responses to essay questions, photograph or video – including my image, likeness, and/or voice for publicity and media purposes. As a practice we make every attempt to let grantees know we are using their image. Note, you have the right to reject permission, and it will not affect your application. We aim to treat you with the greatest respect while we tell the Purple Playas Foundation’s story to the community.

Permission to Share Information

By typing your full name below you are giving permission through electronic signature.

By typing my name below, permission is hereby given to high schools, colleges/universities, federal, state and county officials, trade schools and training/certifications offices to release to Purple Playas Foundation any information concerning my financial aid, academic status, acceptance, attendance, and personal circumstances related to my application and grant eligibility during the duration of my application process and, if awarded the PPF grant, during the duration of my participation in the Anne Nymark Young Adult Furthering Education Grant program.

My authorization signature was given on:

Certification

I certify that all of the information submitted with my application is true and complete to the best of my knowledge. If asked by an authorized official of Purple Playas Foundation, I agree to provide proof of the information I have given. I understand that the inclusion of any false or misleading information, or the exclusion of requested information, will result in the removal of my application from consideration for any award and will necessitate the repayment of any award I do receive.

I understand I must supply all follow-up information by the date requested. I have read the application instructions. I am aware that incomplete or missing information on my application will jeopardize consideration for this award.

Your application will NOT be complete until all the requested supporting items are received:

1. Completed Grant Application
2. Verification of Chronic Illness Form
3. 2 Recommendation Letters

In order for your application to be eligible for consideration, you must complete the following:
(1) Submit all application and supplemental materials to the PPF’s Anne Nymark Young Adult Furthering Education Grant Program by the deadline of June 1, 2023 AND (2) Click on the "Submit" button.

Your application will not be considered for acceptance of this grant unless you comply with Items #1 and #2 stated above. There will be no exceptions!

Please type in your full name below. This serves as your ELECTRONIC SIGNATURE on this application.

Date