HOOVER-KOKEN FOUNDATION, INC



HOOVER-KOKEN FOUNDATION, INC.

STUDENT APPLICATION FOR GRANT-IN-AID

(Application Deadline: May 1)

Please attach a transcript of your previous year's high school or college credits, whichever applies.

Mail to: Hoover-Koken Foundation, Inc.

811 North Washington Street

Junction City, KS 66441

Phone No.: 785-238-3126 Fax No. 785-238-1717

Email Address: edwards@

APPLICANT INFORMATION

Name in full _____________________________________________ Social Security Number ____________________

Home Address _______________________________________ City/State/Zip Code _______________________________

Phone Number _______________________________________

Birth Date ____/_____/_____ Male _______ Female _________

EDUCATION STATUS

Graduate of ____________________________________ High School Year _______

College Classification _____________ Major ________ Minor _______

College or trade school you plan to attend (or are attending):

_____________________________________________________ Name

_____________________________________________________ Address/Aids & Awards Office

_____________________________________________________ City/State/Zip Code

Vocational objective ___________________________________________

Starting Date _________________ Date of Graduation _______________

Note: If you have attended college and are not in attendance at the present time, please explain:

______________________________________________________________________________________

Briefly, summarize your school, church and/or community activities. List any organizations to which you belong and offices you have held.

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Commute ( ) Live on Campus ( ) Other (specify) _________________________________________

Anticipated College Major(s) _______________________________________________________________

Briefly outline your job/career goals

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

EXPENSES AND RESOURCES

Awards are given on the basis of financial need and scholastic potential. Study carefully 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 Resources

Fees and tuition _____________ Personal savings ____________

Books and supplies _____________ Earnings ____________

Room/Board _____________ Aid from parents ____________

Clothing _____________ Aid from Scholarships

Personal & and Grants ____________

Recreation _____________ Other resources (specify) ____________

Other _____________

Total _____________ Total ____________

Indicate what you are doing or will be doing to help meet your anticipated college expenses. Include how you have earned or saved money and what your plans will be for the coming summer.

______________________________________________________________________________________

______________________________________________________________________________________

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REFERENCES

Please give three adult, non-relatives, as references. List one teacher or faculty member from last school attended.

Name Address Position

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

PARENT OR GUARDIAN INFORMATION

Name(s) in full _______________________________________________________________________________________

I live with: ( ) Mother ( ) Father ( ) Step-mother ( ) Step-Father ( ) Other ___________ (please specify

Permanent Home Address _____________________________________________________________________________

Father’s Occupation ___________________ Employer _________________________ Address ______________________

Mother’s Occupation __________________ Employer __________________________ Address ______________________

Children older than you _________ Younger _______ Total number in family ________________

Total Family Income: (Check One)

Under $20,000 ( ) $20,001 - $27,500 ( ) $27,501 - $35,000 ( ) $75,001 - $100,000 ( )

$35,001 - $42,500 ( ) $42,501 - $50,000 ( ) $50,001 - $75,000 ( ) $100,000 - Up ( )

Are there any special family financial considerations you wish the scholarship committee to be aware of?

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

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I hereby authority 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 information from the Social Security Administration, Veterans Administration, Welfare Department and financial institutions such as banks, building and loan companies, etc.

________________________________

Signature - Applicant

________________________________

Signature - Parent

Date _______________________

Hoover-Koken:APPLICATION.5-19-09

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