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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

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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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