RAVE PROGRAM APPLICATION
(Renewing and Advancing through Vocational Education)
Please review the RAVE Program Qualifications and Description to ensure that you meet the criteria before completing this form.
LAST NAME:______FIRST NAME:______
STUDENT ID:______DATE OF BIRTH:______
STREET ADDRESS:______
CITY, STATE, ZIP:______MILE MARKER:______
PHONE: Home (____)______Work (____)______Cell (____)______
EMAIL: ______
CHECK ALL AREAS OF ELIGIBILITY THAT APPLY:
(Please explain at the bottom of page for those items noted as (*).
______Single parent (mother or father)
______Displaced homemaker
______Academically disadvantaged (learning disabled as documented by a physician or counselor)*
______Physically disabled (documented by a physician)*
______Limited English speaking skills and grammar
______Non-traditional student (gender in degree program)*
RACE:______WhiteMARITAL STATUS:____SingleSEX:______Male
______Black____Divorced______Female
______Hispanic____Separated
______Native American____Widowed
______Asian/Pacific Islander____Married/Displaced
______Other____Married
CUSTODY OF MINORS:____Yes ____No If yes, please list below:
NAME
/ AGE / DAYCARE REQUIRED (Y/N) / DAYCARE COST PER WEEK / WESLEY HOUSE ASSISTANCE (Y/N)* Please Explain:______
CRIMINAL RECORD (Y/N): ______
NAME OF A.S. DEGREE, A.A.S. DEGREE OR CERTIFICATE PROGRAM IN WHICH YOU ARE ENROLLED: ______
SECONDARY EDUCATION:____High School Diploma
____GED
____If neither above, highest grade you have completed
POST SECONDARY EDUCATION:____None
____Some (please list)______
____Completed______
LIVING ACCOMMODATIONS:____Rent (government subsidized) $______/month
____Rent (nongovernment subsidized) $______/month
____Own $______/month
____Shelter $______/month
____Live with family member (rent-free)
____Other, please specify______
Do you have a roommate or partner who lives with you other than a dependent? (Y/N) ______
If yes, does that person contribute for rent and other expenses? (Y/N) ______
TRANSPORTATION:____Own carMake/Model______
____Other’s car
____City Bus
____Other
EMPLOYMENT STATUS:____Full-timeINCOME LEVEL:______$0-$10,000
____Part-time______$10,001-$20,000
____Unemployed______$20,001-above
SOURCES OF INCOME (Check all that apply and specify gross amounts received):
SOURCE
/ AMOUNT / MONTHLY / WEEKLY / HOURLY / IF HOURLY, HOW MANY HOURS PER WEEK?Salary/wages (self)
Salary/Wages (spouse)
Spousal Support
Child Support
Social Security
AFDC
Unemployment
Disability
Other
HAVE YOU APPLIED FOR A FEDERAL PELL GRANT AND/OR LOANS? (Y/N)_____
DATE OF APPLICATION______STATUS:______
IF APPROVED FOR RAVE PROGRAM FINANCIAL ASSISTANCE, WHAT ASSISTANCE DO YOU NEED?
____Tuition
____Books
____Childcare (must have an application on file with Wesley House Family Services)
____Transportation (must live more than 10 miles away from campus to qualify)
HOW DID YOU HEAR ABOUT THE RAVE PROGRAM?______
INCOME VERIFICATION: Please provide the following proof of income necessary to determine income eligibility for the RAVE program grants.
______Latest Income Tax Return for self and spouse
AND
______Proof of current income for all household members (provide all as applicable):
_____2-3 current pay stubs
_____Court orders verifying spousal and/or child support
_____Social Security Award Letter
_____Unemployment Compensation Verification
_____Disability Income Verification
_____Proof of other means of support (i.e., parental support, self-employment,
self-employment income, etc.)
I authorize the use of this information or any subsequent information derived from this form with the understanding that the data will be used for general reporting purposes only. I also certify that the information provided in this form is true to the best of my knowledge.
Signature:______Date:______
Please return this completed application and income verification to the RAVE office located in the Financial Aid Office on the Key West campus.
DO NOT WRITE BELOW THIS LINE
Requirement 1, Special PopulationQualifies (Y/N): ______Date:______
Requirement 2, Financial NeedQualifies (Y/N): ______Date:______
Requirement 3, Enrolled in AS orQualifies (Y/N): ______Date:______
Certificate Program
Intake Interview Date: ______
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