Assessment Result: High School Senior

Student is eligible to apply for aid as a High School Senior

Instructions

Complete and submit the Online Application below and upload or fax as many of the required documents ON OR BEFORE JUNE 15th. Should you not have all documents, provide those you have and send remaining as they become available. Remember, paper documents will no longer be accepted and no exceptions will be made.

You will need to provide the following documents. You must either upload your documents to our secure Dropbox, or fax your documents to (620) 342-4701.

STUDENTS must provide copies of the following:

• Most recent complete Federal Tax Return, if filed
• Financial Aid Award Letter for the academic year for which you are applying. This letter must include your name (cannot be handwritten) and must show amounts awarded for EACH semester.
• Official Final High School Transcript. If transcript is not available at the time you apply, submit your application and all other available documents listed and submit your transcript once it is final. Electronic submission is REQUIRED and MUST be uploaded to our secure Dropbox.
• Copy of State-issued Birth Certificate, or Legal Immigration Status Documents.

PARENTS must provide copies of the following:

• Most recent complete Federal Tax Return. If you file a SEPARATE BUSINESS return, you must also provide a copy. If MARRIED and file separate returns, BOTH are required. If you LIVE TOGETHER and both individuals file returns, BOTH are required. Should you have questions, please contact the office.
• Proof of all additional monthly income for previous year, i.e. cash assistance, child support, death and/or survivor benefits, SSDI, SSI, food stamps, military, retirement, unemployment.

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Education Grant Application

"*" indicates required fields

Step 1 of 4

25%

Did student include parent information in the completion of the FAFSA?*

Yes

No

Is student graduating (or has graduated) HIGH SCHOOL in THIS school year?*

Yes

No

Is student a US Citizen or a non-US Citizen in lawful immigration status?*

US Citizen

Lawful Immigrant

Name*

Legal First Name Legal Middle Name Legal Last Name

Student's Personal Information

Have you ever been convicted of a Person Felony?*

Yes

No

Date of Birth*

Month

Day

Year

Last Four Digits SSN*

Gender*

Male

Female

Permanent Resident Immigration Number*

Address*

Street Address (No PO Box) City State ZIP

Student's Preferred Email (cannot be same as parent) Check for Important Info & Copy of Application!*

Student's Preferred Phone*

Student's Preferred Email (cannot be same as parent) Check for Important Info & Copy of Application!*

Student's Preferred Phone (cannot be same as parent)*

County of permanent residence*

Coffey

Lyon

Osage

Number of years resided in County*

From where did you graduate high school?*

High School Graduation Date*

Month

Day

Year

College you will attend. Include specific campus location, if applicable.*

Previous Institution, if transferring.

Declared Major (if undecided, state "undecided")*

NOTE: If attending a Technical College "Undecided" is not an option; you must be enrolled in a specific Program of Study to apply.

Grade level for upcoming academic year:*

Freshman

Sophomore

Junior

Senior

Scholarships

For this academic year, If you HAVE RECEIVED other scholarships, tuition waivers and/or grants that are NOT listed on your institution's Financial Aid Award Letter, provide the following information for each below. DO NOT list any scholarships or grants already included on your institution's Financial Aid Award Letter nor ANY amounts awarded in previous years, as well as any Jones Foundation amounts. Duplication of this information may negatively affect your chances of receiving the Undergraduate Education Grant! At any time after submitting your application this information should change, contact the Jones Foundation office immediately.

Scholarship Information (click the plus sign to add as many scholarships as needed)

Scholarship/Grant Name

Fall Amount Received

Spring Amount Received

Total Received for Year

 

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ATTENTION
The questions below are for
YOUR PARENT(S).

YOUR PARENT(S) must answer these questions regarding
THEIR household information.

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Parent(s)/Legal Guardian(s) Household Information

Parent(s)/Legal Guardian Marital Status:*

Married

Divorced

Widowed

Separated

Living Together

Single (never married)

Custodial Parent Name*

First Name Last Name

Relationship to Student*

Custodial Parent Address*

Street Address City State / Province / Region ZIP

Custodial Parent Employer*

# of years*

Spouse/Partner Name*

First Name Last Name

Relationship to Student*

Spouse/Partner Employer*

# of years*

Contact name for household information questions*

Phone # between 8:30 AM to 5:00 PM*

Parent Email*

Including the student for which you are applying, how many children live in your home? DO NOT include yourself and your spouse/partner in this total.*

If you do NOT file taxes, what is your reason?

If the student for which you are applying is NOT listed as a dependent on your tax return, who claimed & why?

If household income is expected to be less than previous year, provide specific explanation below:

Household Information

Marital Status:*

Married

Divorced

Widowed

Separated

Living Together

Single (never married)

Employer*

# of years*

Spouse/Partner Name*

First Name Last Name

Spouse/Partner Employer*

# of years*

What is the total number of dependent children in the home? DO NOT include yourself and your spouse/partner in this total.*

If you do NOT file taxes, what is your reason?

If household income is expected to be less than previous year, provide specific explanation below:

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ATTENTION
The questions below are for
YOUR PARENT(S).

YOUR PARENT(S) must answer these questions regarding
THEIR additional income, vehicles, assets, and debts.

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Additional Income

In the previous year, if you, your parent(s) or anyone in your household received any of the income listed below, provide the total amount received from January 1 through December 31, enter below and include proof of total amounts received.

Cash Assistance (if none, type $0.00):*

Child Support (if none, type $0.00):*

Death Benefits (if none, type $0.00):*

Disability (if none, type $0.00):*

Food Stamps (if none, type $0.00):*

Military (if none, type $0.00):*

Retirement (if none, type $0.00):*

SSI (if none, type $0.00):*

Unemployment (if none, type $0.00):*

Do you own, are purchasing, or rent your home? (check all that apply)*

Own or purchasing a home

Rent a home or apartment

Rent a lot for a mobile/manufactured home

None of the above

If own or purchasing, what is appraised value of home & acreage?*

Amount of acreage included (if any)

Current payoff amount of mortgage*

If renting, amount paid per month*

First and Last Name of Individual or Company Name to whom rent is paid*

If none of the above, please explain*

Vehicles

Do you own or purchasing a vehicle or vehicles of any kind, including but not limited to, cars, trucks, SUVS, vans, RVs, motorcycles or watercraft?*

Yes

No

Itemize below all vehicles, including, but not limited to, motorcycles, RVs, and watercraft. If nothing is owed, enter $0.00. (Click the plus sign to add as many vehicles as needed.)

List ALL Vehicles, even if value is $0.*

Year

Make/Model

Payoff amt

 

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If no vehicles are owned, please explain:*

Additional Assets

Itemize below all Additional Assets. This includes, but is not limited to, ALL savings, retirement and college savings plans, investment accounts, rental property, additional land, business property and equipment, farm equipment, livestock, crops, etc... List all property by physical address. (Click the plus sign to the right of each line to add as many assets as needed.)

List of Accounts

Savings, Retirement, & College Savings Plans, Investments Accounts, etc...

Market Value

Loan

 

Add Remove

List of Property

Rental Property, Business Property & Equipment, Farm Equipment, Livestock, Crops, etc...

Market Value

Loan

 

Add Remove

Debts

In 'Debts', provide the total payoff balances for any additional bills you owe other than what is previously listed.

Total of All Medical/Dental Bills

Total of All Credit Cards

Total of Other Outstanding Loans not listed in application

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Acknowledgement

By completing this form and signing below, I acknowledge and agree to the following statements:

• The Jones Foundation reviews each application to determine whether the qualifications and eligibility for financial assistance have been met. The Foundation's Board of Trustees , in its sole discretion, has the final decision regarding the qualification, eligibility, and the amount of financial assistance to be awarded.
• This form is an application only. Completing this form does NOT guarantee the receipt of a Jones Foundation educational grant.
• All information provided in this application and supporting documentation is true and accurate to the best of my knowledge and belief.
• I understand that intentional misstatements or falsification of the information in the application will render me immediately ineligible for the Jones Foundation education grant.
• To the extent that I am not able to retrieve academic transcripts from my previous educational institution, the Jones Foundation staff may contact my previous educational institution(s) to obtain my transcript on my behalf.

Electronic Signature

ALL individuals whose information is included is required to sign and date the application before electronic submission.

Student Signature*

Parent/Legal Guardian Signature*

Spouse/Partner Signature*

Date

*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the the information provided in this document.

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