2024 SJICF Scholarship Re-Application

APPLICANT INFORMATION

Last Name*

First Name*

Middle Initial

Permanent Mailing Address*

Address City State ZIP Code

Phone*

Type*

Email*

Date of Birth*

Preferred Pronouns

Occupation*

Employer*

SCHOOL/COLLEGE INFORMATION

College/University/Educational Program*

Address*

City State ZIP Code

Student ID#*

College/University/Program GPA*

Will you be enrolled:*

Full Time

Part Time

If you selected part time, please explain.

What is your projected graduation or completion date (mm/yy)?*

What degree or certification do you expect to receive?*

Intended Career*

How much will your program cost?

Program cost per (choose a time period):

Tuition and fees*

Books, supplies & equipment*

According to IRS regulations, "supplies & equipment" means materials required for every student in the course.

What is the amount of scholarship funding you are seeking from the Foundation?*

PARENTAL/GUARDIAN INFORMATION

If you are a high school senior or undergraduate student under the age of 24, are single, and have no children, you are considered a dependent student for financial aid purposes; parental/legal guardian information must be supplied by a dependent student. Financial information inclusive of income and assets is required for responsible parties, which for this application, can be parents, stepparents, and/or legal guardians. A dependent student should have a least one responsible party but could have more. For example, a student whose parents have divorced and both remarried would have four responsible parties.

Dependent Status*

I qualify as a dependent student.

I do not qualify as a dependent student.

RESPONSIBLE PARTY 1*

Name

Relationship to Applicant*

Occupation*

Employer*

Primary Phone*

Type*

Secondary Phone

Type

Email*

RESPONSIBLE PARTY 2

Name

Relationship to Applicant

Occupation

Employer

Primary Phone

Type

Secondary Phone

Type

Email

RESPONSIBLE PARTY 3

Name

Relationship to Applicant

Occupation

Employer

Primary Phone

Type

Secondary Phone

Type

Email

RESPONSIBLE PARTY 4

Name

Relationship to Applicant

Occupation

Employer

Primary Phone

Type

Secondary Phone

Type

Email

FINANCIAL INFORMATION - CONFIDENTIAL

Annual Income Before Taxes for 2023

(See line 11 of IRS 1040 if filed)

Responsible Party 1*

Responsible Party 2 (enter 0 if not applicable)*

Responsible Party 3 (enter 0 if not applicable)*

Responsible Party 4 (enter 0 if not applicable)*

Self*

Spouse (enter 0 if not applicable)*

Other Income (social security, child support, etc.)*

TOTAL FAMILY INCOME EARNED IN 2023*

Assets and Other Resources

Family Savings, Investments & Trusts*

excluding official retirement accounts

Student's Savings*

Student's Trusts, Funds or Other*

Total Assets & Other Resources*

Total Number in Family*

Number of Dependent(s) Other Than Applicant Currently Attending College*

Please provide detailed information about any financial changes in the status of your family or yourself.*

SUPPORTING DOCUMENTS

The following support materials MUST be received in the San Juan Island Community Foundation office in order to have your application reviewed. If any of these materials are not received, your application will be considered incomplete and not eligible for review for a scholarship.

1. PERSONAL ESSAY*

Submit a short (maximum 600 words) essay describing how you have benefited from the past year's educational experience. Please provide specific examples. This essay should demonstrate your ability to organize thoughts and express yourself; please do not use artificial intelligence. Grammar, spelling, and clarity are important.

2. OFFICIAL TRANSCRIPTS

Please have the latest official transcripts reflecting your units and cumulative GPA to date sent directly from your college and/or other training institution(s) to the San Juan Island Community Foundation via email (scholarships@sjicf.org) or mail (PO Box 1352, Friday Harbor, WA 98250).

3. FEDERAL TAX FILING OR FAFSA/WASFA SUBMISSION SUMMARY*

Please attach a copy of your most recent federal tax filing, your 2024-2025 FAFSA Submission Summary (previously known as the FAFSA Student Aid Report/SAR), or your 2024-2025 WASFA Application.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 512 MB, Max. files: 2.

IMPORTANT! Your application will not be considered complete until all of the above items have been received at the San Juan Island Community Foundation office.

VERIFICATION

I affirm the information included with my application is true and accurate in all respects, and I intend to pursue a degree in higher education. I understand that, if selected, the awarding of funds is contingent upon my enrollment in an accredited institution, and that the funds will be paid directly to the institution and used toward the cost of my education. I authorize SJICF to share this information with SJICF staff, Scholarship Committee members, and donors. I authorize SJICF staff and Scholarship Committee members to contact school officials for additional information, if needed.

Verification Agreement*

I have read and agree to the above verification.

Signature*

Printed Name*

Date*

Parent/Guardian's Signature (If applicant is under 18 years old)

Parent/Guardian's Printed Name

Date

Students

APPLICANT INFORMATION

SCHOOL/COLLEGE INFORMATION

How much will your program cost?

PARENTAL/GUARDIAN INFORMATION

FINANCIAL INFORMATION - CONFIDENTIAL

Annual Income Before Taxes for 2023

Assets and Other Resources

SUPPORTING DOCUMENTS

VERIFICATION