Please print and fill out
Student Information
Name: / DOB:
College Student ID #:
Phone: Email:
Address: City: Zip:
Year Arrived in United States: / Country of Origin: / Languages spoken:
Green Card: yes or no
Process / Citizenship: yes or no / Primary transportation: car or bus
Idaho Driver’s License: yes or no
Education Information
High School: / Graduation
Date: / ACT/SAT Math:
ACT/SAT English:
College attending:
Completed FAFSA? Yes or no / Major: / Anticipated Graduation date:
What other scholarships have you been awarded and how much money do you receive?
Household/Family Information
Number of people in your household? Who is working?
Company name? Pay per hour? $ Hours per week?
Company name? Pay per hour? $ Hours per week?
Government Benefits: Is anyone in your family receiving any of the following:
FOOD STAMPS YES OR NO MEDICAID YES OR NO SS INCOME YES OR NO HOUSING ASSISTANCE YES OR NO
(public Housing or Section 8)
Are you renting or purchasing a home? Rent or purchase
Other concerns or comments:
Referral/recommendation
How did you hear about the one refugee scholarship?
Signature of applicant / Date
Statements of Understanding
(by checking each box, you indicate that you have read and agree to the statement next to the applicable box).
☐The scholarship or grant award is used to further my education, career and the specific purposes indicated by One Refugee Education. I understand that these funds are only to be applied as instructed to me by Refugee One Refugee Education.
☐I understand that this application does not assure a grant will be awarded. One Refugee Education will contact me if and when a grant is awarded. Renewals will be considered on a semester by semester basis.
☐By submitting this grant application, I agree to release and hold harmless One Refugee Education, and its employees, agents, and contractors, from and against any and all claims or causes of actions arising out of or in any way connected with this application, with participation, if any, in One Refugee Education programs, or with any purpose for which grant funds are used.
☐I understand that by signing below, I certify the information is true, correct and complete to the best of my knowledge. I understand that any deliberate false statements are subject to grounds for immediate withdrawal of my student application and, as applicable, the recovery of grants provided and the termination of future participation in One Refugee Education programs.
☐I agree to not use, disclose, or discuss (with anyone other than One Refugee Education’s personnel) One Refugee Education information, including specifics of financial assistance, One Refugee Education records, and copies of and excerpts from those records.
☐I understand that I must adhere to standards and policies established by One Refugee Education. These include but not limited to maintaining a minimum 2.5 GPA, enrolling in 12 credit hours per semester and other standards and all other policies adopted by One Refugee Education.
☐I agree to attend all mandatory orientations and workshops. I agree to participate in school sponsored programs as recommended by One Refugee Education.
☐I agree to fully participate in the Global Talent Idaho job training program as part of the education scholarship program.
☐I understand that there is a volunteer component to the program and I agree to participate as recommended by One Refugee Education.
☐I agree to provide One Refugee Education with employment and wage data as requested up to two years after exiting One Refugee Education.
☐I agree that One Refugee Education may use my personal statement and photo on the One Refugee Education website or for other purposes associated with the Foundation.
______
Print Name
______
Applicant Signature Date
Academic and Career Questionnaire
Please type your answers to each of the below questions in 3-5 detailed sentences.
- What current challenges do you have that affect your ability to be successful in school? (Personal, financial, transportation, family, mental health, etc.)
- What personal qualities or practices have helped you be successful thus far?
- To what extent have you utilized academic advising and university career services and why?
- Describe how you chose your degree. What attracted you to this degree?
- What are your hopes and dreams for the future?
Revised 11/2017