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HOOVER-KOKEN FOUNDATION, INC.
STUDENT APPLICATION FOR GRANT-IN-AID
Please make sure the following is attached or completed before mailing your application:
(Application Deadline: April 15)
• Attach your parent's and/or your federal income tax return for the previous year.
• Attach a transcript of your previous year's high school or college credits, whichever applies.
Return to the Counseling Center of CGHS or Mail to: Hoover-Koken Foundation, Inc
8ll North Washington Street
Junction City, Kansas 66441
****************************************************************
I. PERSONAL INFORMATION
Name Birth Date _______________________
Permanent Address ____________________________ SSN ___________________________
City/State/Zip Code _____________________________ Phone # ________________________
Single ___ Married ___ Number of Children ___ Veteran ___ Discharge Status _____
Do you have any physical disability? _________ If so, explain. ___________________________
______________________________________________________________________________
If planning marriage in the near future, please explain plans.
______________________________________________________________________________
Name of Spouse _______________________________________ Age ____________
Place and type of spouse's employment ______________________________________________
II. EDUCATION STATUS
Graduate of _________________________High School Year _________
College Classification __________ Major ________________ Minor _____________
College or trade school you plan to attend: ____________________________________________
Address (of Aids & Awards Office): ____________________________________________
Vocationalobjective:___________________________________________________
Starting Date __________________ Date of Graduation _____________________
Note: If you have attended college and are not in attendance at the present time, please explain:
______________________________________________________________________
______________________________________________________________________
III. EMPLOYMENT: Describe your work experience to date:
Type of Work Name and Address of Employer Dates
______________________ ___________________ ______________
______________________ ___________________ ___________
______________________ ___________________ ______________
IV. ACTIVITIES AND AWARDS
Hobbies & Talents: List your hobbies, areas of interest and special talents, and also school and community activities.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Distinctions: List offices you have held and honors and awards received by you (agency or institution granting it, the period of the award and its amount)
______________________________________________________________________
______________________________________________________________________
Scholarship and Grants: List academic scholarships or grants you have applied for:
______________________________________________________________________
______________________________________________________________________
IV. EXPENSES AND RESOURCES
Awards are given on the basis of financial need and scholastic potential. Carefully study the latest catalogues from the school of your choice in completing the budget.
Application period beginning ___________ and ending _______________________
(All applications are for a maximum of 12 months only.)
EXPENSES
Fees and tuition ________________
Books and supplies ________________
Board ________________
Room ________________
Clothing ________________
Personal &
Recreation ________________
Other ________________
Total ________________
RESOURCES
Personal Savings ____________
Net earnings during vacation to apply on expenses __________
Part time earnings during School year ____________
Aid from parents or others ____________
Other resources (specify) ____________
Total ____________
REFERENCES:
Please give three adult, non-relatives, as references. List one teacher or faculty member from last school attended.
Name Address Position
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Discuss why you want to obtain further educational training:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
V. CAR QUESTIONS
Do you own a car or motorcycle? ______ Make __________ Year _______________
Equity_______________ Amount owed on vehicle ________________________
Monthly payments _____ Do you have a vehicle for your constant personal use? ___
Please explain ownership, use and need of this vehicle ____________________________________________________________________________________________________________________________________________
__________________________________
Applicant's Signature
PARENTS' CONFIDENTIAL CERTIFICATION
Since the number who can be given grants-in-aid is limited, financial need must be shown, so the
following information is requested of the parents.
I. ____________________________________ ___________ _________________________
Mother's Name Date of Birth Occupation
____________________________________ ___________ _________________________
Father's Name Date of Birth Occupation
II. What county have you lived in continuously for the last year? _________________________
III. List dependent children (not including applicant) and give their ages and grade in school:
_______________________________________________________________________
_______________________________________________________________________
IV. Please attach a statement explaining any special expenses, especially those of a medical
nature. List medical debts or any paid out in the last year. (Do not include payments for
hospital insurance.) Describe any limiting physical disability or medical condition of either
parent.
V. Do you own the home in which you live? Yes ____ No ____
Approximate sale value (if you own home) ___________ Amount of mortgage _________
Name of firm or individual holding mortgage _____________________________________
VI. Other Assets Number Approximate sale value
Cattle ______________ ____________________
Hogs ______________ ____________________
Other livestock ______________ ____________________
Equipment (farm or other business
Equipment) ______________ ____________________
Bonds or other savings ______________ ____________________
VI. Indebtedness (not including car or home payments)
Owed to Amount
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
I hereby authorize the representatives of the Hoover-Koken Foundation, Inc. Junction City, Kansas, to make any financial investigation that is necessary in connection with this application. This may include obtaining
information from the Social Security Administration, Veterans Administration, Welfare Department and financial institutions such as banks, building and loan companies, etc.
___________________________________
Signature - Father
___________________________________________
Signature - Mother
DATE _____________________________
................
................
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