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Organization:
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Contact:
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Applicant Information:
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Social Security Number:
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First Name:
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Last Name:
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Middle Initial:
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I am using estimated numbers (we reserve the right to request verification)
I am using actual numbers
I am: Dependent (complete both columns)
Independent (complete Student columns only)
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If you are a dependent student, please also have your parents complete the form using information from their current Federal Income Tax Return. (If your parents have not filed taxes by the time they are filling this out, they must use estimated numbers). You are a dependent student if you are under 24 years of age and are none of the following: (1) a ward of the court; (2) married and living away from your parents; (3) have not been claimed by your parents for two consecutive years and have earned at least $4000 in each of those two years; (4) served in the military.
If you are an independent student, information about you and your spouse must be included. If you are an independent student, you do not need to furnish information from your parents. Figures should be taken from your current Federal Income Tax Return. (If you have not filed taxes by the time you are filling this out, you must use estimated numbers). You are an independent student if you are 24 years of age or older. If you are under 24, you may claim independent status only if you (1) have served in the military; (2) are a ward of the court; (3) are married and living away from your parents, or (4) have not been claimed by your parents for two consecutive years and have earned at least $4000 in each of those two years.
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Student
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Parent*
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Adjusted Gross Income:
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Total U.S. Income Tax Paid:
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Income Earned From Work By: Self:
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Spouse:
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Untaxed Income And Benefit:
(Child support, AFDC, ADC, SSI, etc.)
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Cash, Savings, Stocks, Bonds, CD's, etc:
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Net value of real estate holding not used as primary:
residence and not business or farm (market value less
balance of mortgage)
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Net Value Of Business Of Farm:
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Total number of family members (If you are:
dependent, your parent's family members.
If independent, you, your spouse and children if any)
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Total number of family members who will be attending:
college at least half-time during the next academic year
(If you are dependent, your parent's family members,
If you are independent, you, your spouse and children,
if any)
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* if living w/custodial parent or other parent
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Do you and/or siblings qualify for free and reduced lunch at school?
Yes No
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Additional Information:
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Parents Current Martial Status:
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single married separated divorced widowed
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Your Current Martial Status:
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single married separated divorced widowed
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If you and your family have unusual circumstances, please explain them below. Examples: tuition expenses at an elementary or secondary school; a family member who recently became unemployed; unusual medical expenses not covered by insurance; other circumstances that affect income.
(Create narrative offline then copy and paste into application - 700 characters max)
0 characters
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Certification:
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I certify that all the information on this form is true and complete to the best of your (our) knowledge and the essay is my own work. If asked by WFACF, I (we) agree to give documentation for information given on this form. I (we) realize that this proof may include a copy of a Federal tax return. I (we) realize that failure to comply with a request for further information may prevent the applicant from being considered for scholarships. I understand that falsification of any kind of any information may result in the termination of the scholarship if one is granted to me.
Signature of Applicant ____________________________________ Date _____________
Signature of Parent ____________________________________ Date _____________
Completed Application Must Be Received By March 15th
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(Your progress will be saved before opening the Scholarship Application)
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